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The  business  problem 


EUSiNESS 
PROBLEMS 

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Presented  by  _ 

DR.  WILLIAM  J.  GIES  ^ 


to  enrich  the  library  resources 
i^m,«  available  to  holders 

W  ofthe 

GlES  FELLOWSHIP 

in  Biological  Chemistry 


/ 


THE   BUSINESS  PROBLEMS 
OF  A   PROFESSION 


THE   BUSINESS   PROBLEMS 
OF  A   PROFESSION 


BY 


FREDERICK   CROSBY   BRUSH,  D.D.S, 

FOUNDER    AND    FELLOW    OF    THE    NEW    YORK    INSTITUTE 
OF   DENTAL  TECHNIQUE  ;    MEMBER   OF  THE   NATIONAL 
DENTAL  ASSOCIATION,    THE    FIRST   DISTRICT   DEN- 
TAL SOCIETY,  STATE  OF  NEW  YORK,  THE  NEW 
YORK  ODONTOLOGICAL  SOCIETY,  THE  NEW 
YORK    INSTITUTE   OF   STOMATOLOGY, 
PSI  OMEGA  FRATERNITY,   ETC. 


NEW  YORK,  N.  Y. 

THE  PRESS  OF  THE  DENTAL  DIGEST 

1911 


1^  I  /     .-'J? 


Copyright,  1911,  by 
FREDERICK  CROSBY  BRUSH,  D.D.S. 


\^ 


CONTENTS. 

CHAPTER  PAGE 

I. — Commencement        .....  i 

II. — Location 7 

III. — Offices 14 

IV. — Office  Arrangement    .        .        .        .  18 

V. — Signs 21 

VI. — Stationery 27 

VII. — ^Advertising 30 

VIII. — Attendant 37 

IX. — Fees 40 

X. — Estimating  the  Cost    ....  46 

XI. — ^TiME 53 

XII.— The  Hour  Fee 58 

XIII. — ^Appointments 60 

XIV. — Reception  of  Patients        ...  63 

XV. — Records  of  Operations       .        .        .  66 

XVI. — ^Journal  and  Ledger  Records  .        .  69 

XVII. — Credits  and  Collections    •        •        •  75 

XVIII. — General  Application  of  the  Hour 

Charge 82 

XIX. — Increasing  the  Fees    ....  84 

XX.— Notes 87 

V 


PREFACE. 

This  little  book  is  the  outgrowth  of  numerous 
short  articles  written  for  dental  journals  and  ad- 
dresses delivered  before  societies.  If  it  proves  of 
assistance  to  brother  practitioners  in  solving  some 
of  their  business  problems,  its  purpose  will  be 
served. 

Twenty  years  of  varied  experiences  in  the  prac- 
tice of  dentistry  together  with  extensive  acquaint- 
ance among  the  practitioners  of  our  chosen  pro- 
fession, have  afforded  the  writer  unusual  oppor- 
tunities for  observing  the  conditions  that  prevail. 
He  is  convinced  that  the  reason  that  some  have 
not  succeeded  as  they  anticipated,  has  not  been  due 
to  their  lack  of  professional  ability  so  much  as  to 
their  lack  of  business  ability  and  a  knowledge  of 
the  business  principles  that  are  involved  in  all 
transactions. 

It  is  the  object  of  this  book  to  supply  informa- 
tion on  this  subject. 

Although  this  work  enters  a  field  which  is  an 
essential  element  of  a  profession,  but  which  has 
been  quite  universally  ignored,  it  is  not  the  writer's 
purpose  to  lay  claim  to  any  originality  for  the 

vii 


Preface. 

methods  or  their  application  as  outlined  in  the  text. 
He  aims  merely  to  present  a  general  plan  which 
may  be  a  guide  for  those  about  to  begin  the  prac- 
tice of  dentistry,  one  that  is  also  adaptable  to 
an  established  practice  and  which  is  being  used 
successfully. 

F.  C.  B. 


viu 


THE    BUSINESS    PROBLEMS    OF    A 
PROFESSION. 

CHAPTER  I. 

"  COMMENCEMENT." 

When  a  young  man  leaves  the  hall  after  the 
college  "  commencement "  exercises  are  over,  he 
feels  that  a  successful  life  lies  before  him  and  that 
all  he  need  do  is  to  engage  an  office,  put  up  a  sign, 
and  patients  will  flock  to  his  door.  Some  days 
afterwards  he  awakens  from  his  dream  to  find  that 
the  key  that  unlocks  the  door  of  business  success 
is  not  an  elaborately  engrossed  diploma  but  that 
it  must  be  slowly  forged  by  hard,  steady  work 
guided  by  a  fixed  purpose. 

As  he  looks  about  him  and  ponders,  he  begins 
to  realize  that  the  privilege  of  adding  the  few  let- 
ters of  a  degree  to  his  name  has  not  changed  the 
conditions  of  life  very  much  for  him;  and  that 
there  are  still  many  battles  to  be  fought  and  won 
before  he  will  be  counted  as  an  important  link  in 
the  economic  chain.  However,  he  is  anxious  to 
begin  at  once  to  hew  his  way  toward  that  success 
of  which  he  has  dreamed ;  but  he  finds  confronting 

I 


The  Business  Problems  of  a  Profession, 

him  several  problems  that  must  be  solved  before 
he  can  make  even  a  fair  start  on  his  chosen  career. 

One  of  his  first  decisions  must  be  whether  he 
shall  at  once  begin  to  establish  a  practice  for  him- 
self or  seek  a  position  as  assistant  in  some  well- 
established  practice,  where  he  will  be  afforded  op- 
portunities to  gain  much  needed  experience,  and  a 
degree  of  self-confidence  that  will  enable  him  to 
cope  with  any  emergency  that  may  arise. 

A  philosopher  has  said  that  a  young  man  begin- 
ning practice  for  himself  immediately  upon  leav- 
ing college,  will  make  more  mistakes  that  will 
injure  his  chances  of  success,  during  the  first  year 
in  practice,  than  he  will  be  able  to  overcome  in  the 
succeeding  five  years.  This  Is  undoubtedly  true 
and,  being  the  case,  it  will,  In  the  long  run,  be  of 
incalculable  benefit  to  a  young  man  to  secure  all 
the  practical  experience  possible  before  beginning 
practice  for  himself,  and  thus  escape  what  is  other- 
wise a  very  considerable  handicap. 

The  time  devoted  to  gaining  experience  Is  well 
spent  and  two  years  Is  little  enough,  while  three  or 
four  years  is  none  too  much.  How  to  get  a  posi- 
tion without  having  had  experience  and  how  to  get 
this  experience  without  a  position  may  seem  a  for- 
midable problem,  and  yet  it  should  not  be  hard 
to  solve  for  an  ambitious  young  man  who  has  a 
good  moral  character  and  plenty  of  grit  and  deter- 
mination.    There  are  several  ways  of  accomplish- 

2 


''  Commencement/* 

mg  the  purpose;  the  most  desirable  one  Is  to 
become  associated  with  some  well-established  prac- 
titioner of  good  repute.  Many  young  men  have 
preceptors  either  before  or  during  their  college 
course,  and  will  be  able  to  continue  on  with  them 
after  graduation.  To  those  who  have  no  such 
affiliations  the  following  suggestions  are  offered : 

In  the  cities  where  the  colleges  are  located  there 
are  usually  one  or  more  professional  organizations 
which  hold  meetings  once  a  month.  Many  of  these 
societies  welcome  senior  students  and  permit  them 
to  attend  meetings  without  any  charge  for  dues  or 
assessments.  At  these  meetings  the  young  man 
will  have  opportunity  to  make  many  valuable  ac- 
quaintances, and  the  chances  will  be  good  for  him 
to  effect  some  arrangement  whereby  he  can  become 
associated  with  one  of  these  men.  The  terms 
and  agreements  in  connection  with  such  an  associa- 
tion will  depend  so  largely  upon  the  individuals 
and  general  conditions,  that  it  is  not  feasible  to 
offer  advice  concerning  them.  Suffice  It  to  say, 
that  If  an  opportunity  offers  to  become  associated 
with  a  progressive  and  aggressive  man  it  will  be 
well  to  take  advantage  of  It  on  the  best  terms  that 
can  be  made.  It  will,  however,  behoove  the  young 
man  to  bear  In  mind  that  the  practitioner  who 
takes  an  Inexperienced  man  Into  his  office  assumes 
a  great  moral  and  legal  responsibility,  and  must 
give  up  much  valuable  time  to  the  proper  instruc- 

3 


The  Business  Problems  of  a  Profession, 

tlon  of  such  a  man.  So  the  young  man  should  not 
allow  his  ideas  of  his  own  ability  and  importance 
to  stand  in  the  way  of  effecting  a  desirable  con- 
nection. 

Another  way  to  get  an  opportunity  to  become 
associated  with  some  good  man  is  to  keep  in  touch 
with  the  dental  depots;  for  there  is  usually  some 
one  there  who  is  a  veritable  information  bureau 
regarding  such  things,  and  very  likely  would  be 
able  to  place  a  man  in  a  very  desirable  position. 
If  the  young  graduate  does  not  care  for  a  city  con- 
nection, then  it  will  be  well  for  him  to  make  the 
acquaintance  of  the  traveling  salesmen  visiting  the 
territory  within  which  he  wishes  to  locate.  When 
seeking  the  assistance  of  these  men  he  should  be 
perfectly  frank  with  them  regarding  his  qualifica- 
tions, what  he  is  willing  to  do,  and  the  terms  he 
will  accept,  but  be  chary  of  estimating  the  value 
of  his  practical  ability. 

It  will  also  be  well  to  watch  the  advertisements 
for  assistants  that  appear  in  the  various  dental 
journals.  When  direct  communication  is  finally 
effected  with  some  practitioner  who  desires  an  as- 
sistant the  young  man  should  be  sure  to  state  all 
the  facts  regarding  his  experience.  It  means  much 
inconvenience  and  disappointment  to  a  busy  man 
to  find  that  the  assistant  from  whom  he  expected 
immediate  help,  must  be  taught  those  things  which 
will  make  his  services  of  value. 

4 


<< 


Commencement.'^ 


There  Is  still  another  avenue  leading  to  experi- 
ence that  Is  always  open — the  advertising  dental 
office.  Mention  of  this  has  been  left  until  the  last 
for  many  reasons;  one  is  that  the  moral  pitfalls 
and  temptations  In  an  advertising  practice  are 
many  and  cannot  be  discussed  here.  Unless  a 
young  man  has  a  strong  moral  character  and  com- 
plete mastery  over  himself  and  his  passions,  I 
should  advise  him  to  avoid  seeking  experience 
through  this  channel.  If  he  is  of  the  stuff  that 
men  are  made  of,  however,  a  couple  of  years'  ex- 
perience In  various  offices  may  be  of  considerable 
value  to  him. 

The  young  man  who  seeks  a  position  as  an  as- 
sistant with  the  Idea  of  obtaining  as  wide  an  expe- 
rience as  possible  before  engaging  In  practice  for 
himself,  will  do  well  not  to  remain  too  long  In  one 
place.  A  good  plan  to  pursue  will  be :  first  get  a 
place  where  all  kinds  of  work  may  be  done;  after 
a  good  idea  has  been  obtained  of  the  general  con- 
duct of  a  practice,  seek  another  place  where  special 
work  can  be  done.  For  instance,  first  get  a  good 
idea  of  general  practice;  then  take  up  extracting; 
follow  this  by  doing  all  kinds  of  gold  work;  spend 
some  time  doing  general  prosthetic  work,  and  wind 
up  with  general  operating  and  prophylaxis  work. 
The  man  who  will  devote  two  or  three  years  to  the 
carrying  out  of  such  a  program  will  have  obtained 
in  return  the  best  post-graduate  course  in  dentistry 

5 


The  Business  Problems  of  a  Profession. 

that  it  IS  possible  under  present  conditions  to  re- 
ceive. Do  not  think  that  such  a  plan  is  a  mere 
theory  that  could  not  be  carried  out,  for  it  has  been 
done  in  a  number  of  instances  and  can  be  again  by 
any  man  who  has  the  moral  courage  to  undertake 
it  and  the  grit  to  see  it  through. 


CHAPTER  II. 

LOCATION. 

Where  to  locate  is  probably  the  most  impor- 
tant question  that  a  young  man  will  have  to  deal 
with  during  his  entire  professional  career.  Whether 
the  future  shall  bring  success  or  failure  may  de- 
pend very  largely  upon  the  decision  at  this  time. 
Some  men  seem  able  to  move  along  the  line  of 
least  resistance  and  find  good  fortune  always  await- 
ing them;  but  there  are  other  poor  mortals  who 
find  It  necessary  to  ponder  carefully  over  every 
new  move  and  situation,  and  to  exercise  matured 
judgment  in  order  to  avert  a  catastrophe. 

This  is  a  subject  about  which  it  is  hard  to  offer 
advice;  men  differ  so  widely  in  temperament,  In- 
dividuality, and  inclinations  that  it  is  difficult  to 
foresee  what  conditions  will  have  to  be  met.  There 
are,  however,  some  major  things  that  should  be 
given  consideration  when  a  man  is  selecting  a  lo- 
cation for  his  future  activities. 

The  first  of  these  is  the  question  of  health. 
Some  men  are  so  constituted  that  they  are  greatly 
affected  by  climatic  conditions.  When  a  man  Is 
sensitive  to  such  Influences,  he  should  be  partlcu- 

7 


The  Business  Problems  of  a  Profession. 

larly  careful  not  to  plunge  into  some  place  because 
there  seems  to  be  a  good  opportunity  for  immedi- 
ate business.  He  should  study  all  the  conditions 
thoroughly;  for  health  is  one  of  the  greatest  busi- 
ness assets  a  man  can  have.  If  climatic  conditions 
are  such  that  health  cannot  be  maintained,  he  will 
be  most  seriously  handicapped  at  a  time  when  it 
will  seem  too  late  to  begin  all  over  again  in  some 
place  where  the  climate  is  more  favorable. 

To  an  ambitious  young  man  a  large  city  will 
seem  to  present  unlimited  possibilities.  There  will 
be  opportunities  to  affiliate  with  large  professional 
organizations,  to  meet  and  become  acquainted 
with  men  of  note  in  the  profession,  to  build  a  large 
practice  and  receive  high  fees,  and  to  pursue  his 
own  course  through  life  uninterrupted  by  the  petty 
criticisms  that  are  coincident  with  life  in  many 
small  communities.  But  life  in  a  large  city  is  not 
all  smooth  sailing.  It  means  heavy  expenses  that 
seem  to  be  ever  increasing,  meager  opportunities 
for  making  social  acquaintances  that  are  worth 
while,  inadequate  means  of  becoming  profession- 
ally known  to  the  public,  and  the  long  heart- 
breaking struggle  to  gain  a  practice  that  yields  a 
sufficient  income  to  enable  one  to  enjoy  the  real 
pleasures  of  a  city  life. 

A  suburban  community  adjacent  to  some  large 
city  will  present  opportunities  that  will  appeal  to 
many.    In  such  a  place  the  practice  will  be  a  family 

8 


Location, 

one,  and  the  clientele  principally  women  and  chil- 
dren. Fees  may  not  be  as  high  but  the  expenses 
will  be  materially  less. 

Such  communities  generally  present  many  social 
opportunities  and  advantages,  and  a  young  man 
with  a  pleasing  personality  should  be  able  to  make 
acquaintances  rapidly.  By  exercising  judgment  in 
the  making  of  Intimate  friends  and  by  avoiding  as- 
sociation with  any  particular  clique,  he  will  soon 
be  able  to  determine  what  people  are  worth  know- 
ing and  whose  patronage  he  will  desire.  It  will  be 
well  to  become  associated  with  the  civic  organiza- 
tions and  take  an  active  part  in  any  movement  for 
the  betterment  of  the  place,  but  as  far  as  possible 
avoid  being  mixed  up  in  what  Is  generally  called 
"  local  politics."  This  advice  will  hold  good  for 
larger  communities,  for  it  has  been  observed  that 
when  a  member  of  the  medical  profession  succeeds 
in  politics  or  becomes  a  politician,  it  is  usually  at 
the  expense  of  professional  success. 

A  good  suburban  town  usually  presents  many 
almost  ideal  advantages.  In  such  a  place  one  can 
enjoy  the  pleasures  of  a  real  home  with  its  lawn 
and  garden,  its  flowers  and  trees  and  the  accom- 
panying incidentals  that  help  to  make  life  worth 
living.  It  is  also  possible  to  reach  the  city  easily, 
which  gives  a  progressive  man  an  opportunity  to 
attend  and  take  part  in  the  meetings  of  profes- 
sional organizations  and  thus  keep  in  touch  with 

9 


The  Business  Problems  of  a  Profession, 

advanced  theories  and  methods.  These  are  ad- 
vantages not  to  be  thought  lightly  of  when  a  choice 
Is  being  made  of  a  place  wherein  one  Is  likely  to 
spend  the  greater  part  of  a  lifetime. 

A  manufacturing  city  or  town  presents  some- 
what different  conditions  for  consideration.  Local 
business  Is  dependent  upon  trade  conditions  and 
the  steady  employment  of  wage  earners.  When 
the  country  Is  prosperous  and  there  Is  a  good  de- 
mand for  manufactured  products,  the  people  will 
be  employed,  money  will  circulate  freely,  and  all 
will  be  well.  But  In  case  of  a  financial  panic  or  a 
general  trade  depression.  Industrial  centers  are  usu- 
ally the  first  to  feel  the  effects,  and  a  money  strin- 
gency follows. 

As  the  care  of  the  teeth  and  mouth  Is  still  looked 
upon  as  somewhat  of  a  luxury  by  the  wage-earning 
class,  the  dentist  will  be  the  first  whose  business 
will  be  affected,  and  Instead  of  receiving  cash  he 
will  have  to  give  credit.  He  will  be  the  one  whose 
lost  time  and  opportunities  are  the  hardest  to  make 
up.  If  the  bulk  of  one's  practice  consists  of  wage 
earners  or  their  dependents,  it  will  be  necessary  to 
be  continually  on  the  alert  In  order  to  be  prepared 
to  meet  and  go  safely  through  these  periods  of 
business  depression.  In  such  places  the  amount  of 
business  that  a  dentist  can  do,  together  with  the 
kind  of  operations  and  the  fees  that  can  be  charged, 
will  depend  very  largely  upon  the  class  of  people 

10 


Location, 

employed  and  the  wages  they  receive.  If  a  town 
has  Industries  of  many  different  kinds,  trade  con- 
ditions are  not  likely  to  become  as  acute  as  they 
would  If  but  one  industry  was  depended  upon.  A 
town  dependent  upon  one  kind  of  Industry  for  Its 
prosperity  should  not  be  looked  upon  favorably 
as  a  place  In  which  to  locate,  unless  the  opening 
seems  an  unusually  good  one. 

A  country  town  or  village  with  a  tributary 
farming  population  may  possess  attractions  to  one 
who  will  be  content  to  lead  an  uneventful  existence. 
The  social  requirements  and  activities  of  such 
places  are  usually  decidedly  limited.  Any  especial 
stimulus  for  mental  exertion  will  be  lacking,  and 
he  win  be  an  unusual  man  Indeed  that  does  not 
get  Into  a  rut  and  drift  along  from  day  to  day, 
following  the  lines  of  least  resistance.  General 
expenses  may  not  be  as  great  as  In  larger  commu- 
nities, but  It  will  be  found  here  as  elsewhere  that 
all  things  are  relative  and  that  the  expense  account 
will  be  In  about  the  same  ratio  to  the  amount  of 
business  that  can  be  done,  as  In  other  places.  The 
gross  annual  practice  In  such  communities  averages 
about  $2,500.  Many  credit  accounts  have  to  be 
carried,  and  collections  are  slow  and  In  small 
amounts.  Money  can  be  earned  and  by  close 
economy  It  may  be  saved  In  these  communities,  but 
very  seldom  Is  money  made  In  the  sense  that  the 
term  is  generally  used  In  the  business  world, 

II 


The  Business  Problems  of  a  Profession, 

Business  Openings. 

It  has  been  said  in  a  general  way  regarding  the 
population  of  communities  that,  iive  hundred  peo- 
ple will  support  a  physician,  while  at  least  one 
thousand  will  be  required  to  support  a  dentist. 

In  the  large  cities  the  proportion  of  dentists  to 
the  population  need  scarcely  be  considered,  as  such 
places  are  continually  growing,  and  there  are  al- 
ways opportunities  for  aggressive  and  progressive 
men  to  gain  a  following.  The  same  may  be  said 
of  the  immediate  suburbs  of  the  largest  cities. 

When  a  manufacturing  city  or  town  is  being  con- 
sidered, a  much  more  liberal  numerical  allowance 
should  be  made,  for  in  these  places  the  quality  of 
the  people  will  be  of  far  more  importance  than  the 
quantity.  It  will  be  well  to  inquire  into  the  gen- 
eral characteristics  and  nationality  of  the  wage 
earners,  the  average  weekly  wage  received,  whether 
continuously  employed  throughout  the  year  or 
only  during  trade  seasons;  the  average  yearly  in- 
come of  the  different  classes  of  people  comprising 
the  population,  and  whether  the  people  are  thrifty 
and  spend  money  judiciously,  or  support  a  large 
number  of  saloons  and  catch-penny  stores  and 
amusement  places;  for  the  general  business  condi- 
tions of  the  place  will  be  very  largely  governed  by 
these  things. 

The  possibilities  of  building  up  a  paying  prac- 

12 


Location. 

tice  In  a  country  community  will  depend  very 
largely  upon  the  productivity  of  the  surrounding 
country;  if  it  is  a  farming  or  fruit-growing  center 
and  modern  methods  are  employed  so  that  large 
returns  are  yielded,  then  the  chances  will  be  much 
better  than  they  would  be  in  a  place  where  the  soil 
is  barren  or  worked  out  and  the  people  only  grub 
out  a  bare  living,  with  little  left  to  supply  the 
needs  for  physical  comfort. 

Mention  is  made  of  these  matters  for  the  pur- 
pose of  giving  a  general  idea  of  some  of  the  things 
worth  considering  when  seeking  a  place  wherein 
a  practice  may  be  established  that  will  yield  a 
suitable  income. 


13 


CHAPTER  III. 

OFFICES. 

After  a  decision  has  been  reached  regarding  a 
place  in  which  to  locate,  the  next  thing  will  be  to 
seek  a  suitable  office.  In  the  larger  cities  the  tend- 
ency at  present  is  to  have  an  office  in  one  of  the 
modern  office  buildings  or  In  some  building  occu- 
pied exclusively  by  medical  specialists.  Such  a 
situation  is  desirable  from  many  standpoints,  but 
is  more  suitable  for  a  man  with  an  established 
practice  than  for  one  just  beginning;  the  expenses 
connected  with  such  an  office  are  usually  high,  and 
the  opportunities  of  securing  chance  or  transient 
patients  are  reduced  to  the  minimum. 

A  second  choice  might  be  the  securing  of  accom- 
modations in  a  private  house  or  an  apartment. 
This  will  have  the  advantage  of  bringing  one  in 
contact  with  a  family  neighborhood,  but  it  also 
has  its  disadvantages,  especially  If  one  resides  In 
the  house;  for  then  it  will  be  difficult  to  establish 
and  maintain  suitable  office  hours,  something  which 
in  the  long  run  is  almost  imperative  from  a  good 
business  standpoint. 

Another  possible  location  would  be  in  rooms 

14 


Offices. 

over  a  store  on  some  business  street  or  avenue.  In 
making  such  a  selection  care  should  be  exercised 
regarding  the  general  character  of  the  building 
and  its  tenants,  the  class  and  kind  of  stores,  and 
the  accessibility,  care,  and  condition  of  the  entrance 
hall. 

In  a  suburban  place  the  best  location  is  generally 
in  a  private  house  on  the  main  street  or  in  close 
proximity  to  the  business  center.  If  this  is  not  ob- 
tainable, the  next  best  place  will  be  in  some  bank 
building  or  over  the  leading  drug  store.  If  possi- 
ble, avoid  locating  over  notion  shops,  grocery 
stores,  or  markets  of  any  kind. 

In  small  cities  or  towns  it  is  customary  to  find 
dental  offices  located  in  business  buildings  on  the 
main  thoroughfares,  but  It  will  be  found  that  here, 
as  in  suburban  towns,  an  office  In  a  well-situated 
private  house  will  be  most  desirable.  Above  all 
things,  avoid  having  an  office  located  over  a  saloon 
or  a  cigar  store,  or  in  any  building  whose  entrance 
or  approach  is  a  congregating  place  for  men  and 
street  gossips.  Be  sure  that  there  is  nothing  about 
the  building  or  entrance  that  will  deter  ladies  or 
children  from  feeling  free  to  come  and  go  at  all 
times.     These  points  are  pertinent  to  any  place. 

When  locating  in  a  business  building  be  sure 
that  the  entrance  to  the  office  is  direct,  easy  of  ac- 
cess, and  that  the  hallways  and  stairs  are  light  and 
kept  clean.   These  conditions  are  all  too  frequently 

15 


The  Business  Problems  of  a  Profession. 

disregarded,  and  are  noted  and  commented  upon 
by  patients  more  often  than  we  would  like  to  be- 
lieve. First  impressions  are  usually  lasting,  and  . 
it  has  often  happened  that  prospective  patients 
have  turned  away  and  gone  elsewhere,  when  con- 
fronted by  a  crowded  entrance  or  a  dirty  stairway 
leading  to  a  dingy,  unkept  hallway.  One  would 
not  expect  to  find  a  neat,  wholesome  gentleman 
and  a  sanitary  office  awaiting  them  in  the  midst  of 
such  surroundings. 

In  selecting  an  office,  light  and  ventilation  are 
two  essentials  that  must  be  given  the  greatest  con- 
sideration. It  is  a  generally  accepted  theory  that 
a  north  light  is  the  best  for  operating  purposes, 
but  from  having  worked  all  around  the  compass  it 
is  the  writer's  conclusion  that  a  southwest  light 
presents  the  most  advantages.  From  this  point 
direct  light  will  be  obtained  for  the  longest  time 
during  the  day  throughout  the  year ;  the  lights  and 
shadows  from  sun  rays  and  passing  clouds  will 
cause  less  eye  strain  and  fatigue  than  will  the 
steady  reflected  light  from  the  north.  It  is  un- 
healthy to  spend  the  greater  part  of  the  day — day 
in  and  day  out — In  a  room  into  which  the  sun's 
rays  do  not  enter.  Such  a  condition  is  a  greater 
cause  of  eye  strain  and  nervous  irritability  than  is 
generally  realized. 

Note  also  the  toilet  accommodations;  for  a 
clean,  well-appointed  toilet  room  is  an  important 

i6 


Offices. 

adjunct  to  a  professional  office  and  a  convenience 
that  will  be  greatly  appreciated  by  patients. 

Look  carefully  Into  the  heating  and  plumbing 
arrangements  and  see  that  they  are  adequate.  A 
city  man  who  failed  to  give  these  things  careful 
consideration  had  a  rather  unpleasant  experience. 
He  found  an  office  that  seemed  to  suit  his  require- 
ments, and,  after  signing  a  lease  for  a  term  of 
years,  moved  in;  when  about  to  set  up  the  foun- 
tain cuspidor  It  was  discovered  that  the  water  out- 
let was  some  thirty  feet  away  from  where  the  oper- 
ating chair  must  stand  and  that  the  floor  was  con- 
structed of  railroad  Iron  and  filled  In  with  concrete 
and  ashes  and  then  covered  with  the  usual  hard- 
wood flooring.  It  cost  a  pretty  penny  to  overcome 
the  difficulty. 


17 


CHAPTER  IV. 

OFFICE   ARRANGEMENT. 

The  arrangement  of  an  office  or  suite  of  rooms 
will  depend  so  much  on  circumstances  and  indi- 
vidual taste,  that  it  is  not  practicable  to  do  more 
than  offer  a  few  suggestions. 

The  simplest  plan  is  to  divide  the  room  or 
rooms  so  as  to  present  a  reception  room,  an  oper- 
ating room,  a  dressing  room,  and  a  laboratory. 

The  reception  room  need  not  be  large,  but  it 
should  be  so  situated  that  it  will  be  well  lighted 
and  easily  ventilated.  The  furniture  should  be 
plain  and  good,  and  should  exhibit  taste  rather 
than  ornate  display.  Do  not  overcrowd  the  room 
with  furniture;  a  few  comfortable  chairs  and  a 
center  table  are  worth  more  than  a  truck  load  of 
junk.  A  few  carefully  selected  high-class  pictures 
are  always  desirable,  but  above  all  things  avoid 
cluttering  up  the  walls  with  cheap  prints,  so-called 
"  art  "  calendars,  amateur  photographs,  class  pic- 
tures or  diplomas,  and  last,  but  worst  of  all,  any 
colored  or  carbon  enlargements  of  photographs  of 
yourself  or  members  of  your  family. 

Keep  the  table  well  supplied  with  current  maga- 
zines,  a   few  books  of  short  stories,   some  well- 

i8 


Office  Arrangement. 

selected  children's  books,  and  a  dally  newspaper. 
Don't  waste  money  on  sets  of  subscription  books 
to  repose  peacefully  (and  dustily)  In  a  case  In  the 
reception  room.  This  refers  to  books  containing 
copies  of  the  world's  famous  paintings,  speeches  of 
great  orators,  selected  poetry  and  choice  literature, 
and  the  usual  run  of  such  things  that  are  offered  to 
professional  men;  you  will  never  read  them  nor 
will  anyone  else  be  likely  to  do  so.  When  ready  to 
buy  books,  get  the  standard  authors  and  miscel- 
laneous books  on  subjects  that  are  worth  while — 
the  kind  that  you  would  really  like  to  read. 

If  a  separate  room  Is  not  available  for  a  dress- 
ing room,  sufficient  space  should  be  partitioned  or 
screened  off  from  the  reception  room  to  contain  a 
coat  tree,  a  dressing  table,  mirror,  etc.  This  is  a 
convenience  that  will  be  greatly  appreciated,  for 
few  people  like  to  leave  their  coats  and  bonnets 
scattered  about  on  chairs;  and  ladles  do  not  care 
to  be  compelled  to  arrange  their  hair  and  prepare 
for  the  street  In  the  presence  of  strangers. 

The  operating  room  should  have  ample  space 
for  the  chair,  cabinets,  and  other  necessary  equip- 
ment, and  also  for  a  desk,  safe,  etc.;  for  this  is  the 
proper  place  for  all  that  pertains  to  the  business 
side  of  a  practice.  Some  very  good-looking  work 
benches  are  made  that  may  be  placed  In  the  oper- 
ating room  if  one  desires;  but  as  the  public  has 
been  accustomed  to  look  upon  the  profession  of 

19 


The  Business  Problems  of  a  Profession, 

dentistry  as  so  largely  mechanical,  it  would  seem 
that  if  we  hope  to  successfully  combat  this  idea,  it 
would  be  better  to  relegate  such  evidences  of  our 
mechanics  to  a  less  conspicuous  place. 

The  laboratory  should  be  so  situated  as  to  be 
of  easy  access  from  the  operating  room,  but  should 
be  separate  and  distinct,  so  that  it  may  be  closed 
off  tightly  to  prevent  noise  and  odors  from  reach- 
ing the  other  rooms. 

A  better  idea  of  the  equipment  necessary  to  meet 
one's  requirements  can  be  gained  from  the  cata- 
logs of  supply  houses  than  from  anything  that 
might  be  written  in  a  book  of  this  nature. 

For  decorations,  plain  soft  colors  are  more 
pleasing  than  are  the  gaudy,  flower-bedecked  wall 
papers  often  used.  The  soft  grays,  greens,  or 
browns  are  desirable,  but  red  is  an  excitant  and 
should  not  be  used.  In  the  operating  room  a  soft 
gray  or  green  will  be  preferable  to  a  dead  white, 
for  that  is  apt  to  produce  a  glare  and  cause  an  un- 
necessary strain  on  the  eyes.  For  the  operating 
room,  white  enameled  cabinets,  etc.,  are  having 
quite  a  vogue,  presumably  because  white  is  the  em- 
blem of  cleanliness;  but  white  enamel  can  be  about 
the  dirtiest  of  things,  for  it  does  not  show  dust 
which  is  consequently  very  often  overlooked,  and 
when  the  enamel  finally  becomes  stained  it  is  most 
unsightly.  Cleanliness  should  be  a  matter  of  prin- 
ciple rather  than  of  color  in  an  operating  room. 

20 


CHAPTER  V. 

SIGNS. 

The  question  of  signs  will  merit  consideration 
after  an  office  has  been  secured  and  equipped. 
The  purpose  of  a  sign  is  to  furnish  information 
and  guidance.  The  purpose  of  a  professional 
man's  sign  is  to  inform  the  public  that  a  certain 
person  is  practising  a  certain  profession  in  a  cer- 
tain place,  and  to  serve  as  a  guide  whereby  his 
office  may  be  readily  located.  It  would  seem  to 
follow  that  any  sign  that  fulfilled  this  purpose 
would  be  proper,  but  this  is  not  wholly  so,  for  ap- 
propriateness and  good  taste  must  be  considered. 

A  big,  flaring  sign  with  striking  colors  that  at- 
tracts attention  from  a  considerable  distance  is,  in- 
deed, a  sign;  but  as  it  is  an  offense  to  the  eye  and 
indicates  a  lack  of  taste  and  professional  dignity  on 
the  part  of  the  one  by  whom  it  is  used,  it  is  Inap- 
propriate for  anyone  who  wishes  to  attract  the 
patronage  of  refined  people. 

On  the  other  hand,  there  is  the  sign  which  is  so 
small  and  indistinct  and  placed  in  such  an  obscure 
position  that  it  can  only  be  found  and  read  after 
a  most  diligent  search.    Two  such  cases  come  read- 

21 


The  Business  Problems  of  a  Profession. 

Ily  to  my  mind:  one  Is  on  a  residence  street  in 
New  York  City,  and  the  man's  name  is  so  lightly 
traced  in  the  corner  of  the  parlor  window  that  it 
can  be  seen  from  the  street  (ten  feet  away)  only 
when  the  light  or  the  position  of  the  observer  is 
just  right.  In  this  case  the  number  of  the  house  Is 
also  hidden  from  view,  so  that  any  stranger  look- 
ing for  this  man's  office  is  practically  compelled  to 
seek  the  assistance  of  the  neighbors  or  the  numbers 
on  their  houses.  The  other  case  is  in  a  country 
town  and  the  office  is  located  on  the  main  street. 
I  was  seeking  this  particular  man  and  upon  inquiry 
was  not  told  the  house  number  but  that  his  office 
was  on  a  certain  block.  I  passed  along  three  times 
without  locating  him,  and,  finally,  inquired  again 
and  was  assured  that  I  was  on  the  right  block. 
Once  more  I  went  along,  peering  carefully  into 
each  hallway  and  finally  behind  a  half-closed  outer 
door  found  his  name  in  tiny  letters  upon  an  Inner 
door  that  could  not  be  seen  from  the  street  under 
ordinary  conditions. 

Neither  extreme  serves  the  real  purpose  of  a 
good  sign,  for  one  keeps  desirable  patients  away 
by  offending  their  sense  of  good  taste,  while  the 
other  exhausts  their  patience. 

Some  vulgar  men  have  gone  to  such  an  extreme 
In  flaunting  flaring  signs  that  ultra-ethical  men 
propose  going  to  the  other  extreme  and  advocating 
the  doing  away  altogether  with  signs  of  any  de- 

22 


Signs, 

scrlptlon.  Both  attitudes  are  unwise  and  unde- 
sirable. 

If  the  office  selected  be  in  a  private  house  situ- 
ated close  to  the  street,  a  sign  might  be  placed  in 
a  front  window  where  it  can  be  readily  seen  by  the 
passer-by.  In  this  case  it  should  be  of  modest  size 
and  of  the  nature  of  those  generally  used  by  medi- 
cal men;  it  may  include  with  the  name,  the  letters 
of  the  professional  degrees  or  the  words  dentist  or 
dental  specialist,  in  order  not  to  be  mistaken  for  a 
physician.  If  the  house  be  well  back  from  the 
street,  so  that  a  sign  in  the  window  would  not  be 
desirable,  it  can  be  placed  on  the  porch  railing  or 
steps  at  the  entrance  but  so  situated  as  to  be  plainly 
visible. 

When  an  office  is  situated  on  an  upper  floor  of 
a  business  building,  it  is  well  to  have  a  small  sign 
or  tablet  placed  in  the  entry  with  the  number  of  the 
floor  or  room,  together  with  the  name  upon  it  to 
serve  as  a  guide  for  finding  the  office.  If  in  this 
case  the  office  windows  can  be  readily  seen  from 
the  street,  the  name  and  specialty  can  be  placed  in 
one  of  them  with  modest-sized  plain  gold  letters. 

Any  of  the  so-called  decorative  or  plain  wood 
signs  attached  to  the  outside  of  a  building  are  usu- 
ally objectionable  and  in  poor  taste.  It  seems  un- 
necessary to  comment  on  poster  signs,  announcing 
special  kinds  of  work,  price,  etc.,  that  remind  one 
of  a  fire  sale  in  a  shoddy  clothing  store. 

23 


The  Business  Problems  of  a  Profession, 

In  selecting  the  lettering  for  a  sign,  avoid  all 
attempts  at  ornate  display,  and  fancy  letters  of  all 
kinds — stick  to  the  plain,  quiet  dignity  of  the  sim- 
ple Roman  letter  which  can  be  read  at  a  glance. 

One  of  the  antiquated  and  illogical  notions  of 
the  medical  professions  regarding  signs  is,  that  it 
is  not  strictly  proper  for  a  specialist  to  announce  his 
specialty  upon  his  sign.  This  may  be  all  right 
from  the  ultra-conservative  standpoint  from  which 
they  argue,  but  it  does  not  seem  to  take  into  con- 
sideration the  convenience  of  one  of  the  most  in- 
terested parties — the  public.  The  medical  man 
needs  the  public  (patients)  quite  as  much  or  more 
than  the  public  needs  him,  and  yet  if  he  adheres 
strictly  to  the  code  laid  down  for  his  guidance  he 
must  not  do  anything  that  will  enable  the  general 
public  to  know  that  he  is  in  business  and  desires 
their  patronage,  or  that  he  has  any  especial  fitness 
for  special  work  and  desires  to  practise  that  exclu- 
sively. 

From  the  standpoint  of  the  public,  consider  how 
difficult  it  is  to  locate  and  determine  anything 
about  some  individual  practitioner,  to  learn  some- 
thing of  his  habits,  his  character,  temperament, 
individuality,  etc.  It  would  seem  as  though  the 
public  was  expected,  when  in  need  of  medical  serv- 
ices, to  walk  down  some  street,  or  streets,  until  a 
sign  could  be  found,  use  second  sight  to  determine 
whether  it  is  the  office  of  an  oculist,  aurist,  dentist, 

24 


Signs. 

surgeon,  or  general  practitioner,  and  then  walk  In 
and  unburden  Itself  to  whatever  sort  of  man  hap- 
pened to  be  behind  the  sign. 

Or  else  the  seeker  Is  expected  to  Inquire  of  some 
friend.  In  whose  advice  and  judgment  he  has  no 
great  amount  of  confidence  and  who,  perhaps,  in 
turn  Is  not  wholly  satisfied  and  would  like  to  make 
a  change  of  dentist  if  It  were  not  too  much  like 
making  a  leap  In  the  dark. 

Consider  how  disquieting  It  Is  to  one's  peace  of 
mind,  when,  In  an  emergency,  one  tries  to  locate 
a  physician  and  In  desperation  calls  up  someone  at 
random  only  to  find  that  It  Is  a  dentist  or  an  oculist 
or  some  specialist  other  than  Is  needed,  and  that 
valuable  time  has  been  lost. 

Does  It  not  seem  reasonable  that  if  we  desire 
the  good  will  and  patronage  of  the  public,  we 
should  show  consideration  enough  to  designate  on 
our  signs  or  cards  the  special  branch  of  the  profes- 
sion that  we  desire  to  pursue,  in  order  to  spare 
their  time  and  patience? 

The  medical  profession  has  made  great  strides 
and  kept  pace  with  the  times  In  nearly  everything 
except  its  code — but  with  that,  If  some  man  dare 
differ  with  the  literal  precepts,  although  not  the 
spirit,  he  is  frowned  upon  as  a  heretic  (but  some- 
times secretly  commended  for  his  courage). 

The  objection  to  a  man  announcing  himself  as 
a  specialist  originated  at  a  time  when  speclaliza- 

25 


The  Business  Problems  of  a  Profession. 

tion,  as  it  is  practised  to-day,  was  literally  un- 
known. The  position  taken  at  that  time  may  have 
been  justified,  but  it  seems  as  though  it  is  now  time 
for  a  liberal  profession  to  take  more  liberal  views 
and  meet  present-day  problems  in  a  logical  way. 


26 


CHAPTER   VI. 

STATIONERY. 

A  PROFESSIONAL  man's  stationery  Is  his  envoy 
to  people  whom  he  cannot  at  the  time  meet  per- 
sonally. It  represents  him,  and  by  it  he  is  fre- 
quently judged.  This  being  the  case,  it  behooves 
the  dentist  to  spare  no  expense,  but  to  have  all  sta- 
tionery of  the  best  quality  and  in  good  taste,  so 
that  the  impression  conveyed  may  be  favorable. 
The  printing  on  the  business  cards  and  letter-heads 
used  by  some  dentists,  to  say  nothing  of  the  qual- 
ity of  the  paper,  resembles  that  used  by  emigrant 
sign  painters  and  Polack  tailors.  Their  visible 
cheapness  stamps  the  user  as  cheap  also.  They 
contain  much  information  that  is  nonessential,  un- 
necessary, and  out  of  place.  If  one  wishes  to  ad- 
vertise, it  is  better  to  do  it  deliberately  than  to  have 
what  should  be  a  professional  card  look  like  a 
handbill. 

A  professional  card  should  be  engraved — that  Is 
essential.  The  lettering  should  be  plain  and  clear 
— that  is  good  taste.  The  card  should  be  small  in 
size  and  contain  the  name  and  full  address  (street, 
number,  and  town).    It  should  designate  that  one 

27 


The  Business  Problems  of  a  Profession, 

IS  a  dentist,  by  the  use  of  the  letters  of  the  profes- 
sional degree  after  the  name,  or  the  words  dentist 
or  dental  surgeon  in  small  letters  underneath  the 
name.  If  it  is  to  be  the  card  of  a  specialist  then 
the  name  of  the  specialty  should  be  placed  in  the 
lower  left  corner.  It  is  permissible  to  mention  the 
telephone  number  and  the  office  hours  if  one  de- 
sires to  do  so,  but  as  these  are  usually  understood 
and  only  tend  to  detract  from  the  neatness  and 
dignity  of  the  card,  it  is  generally  well  to  leave 
them  off. 

Letter-paper  should  be  of  the  very  best  quality 
and  of  the  standard  sizes  only — the  small  double 
sheet  for  notes  and  the  medium  size,  square,  two- 
fold sheet  for  letters,  with  envelopes  to  match. 

The  letter-head  should  consist  of  the  name  and 
full  address  and  should  be  embossed;  if  this  is  not 
obtainable  the  printing  should  resemble  engraving 
as  closely  as  possible.  The  style  of  lettering 
should  be  the  same  as  that  used  on  the  professional 
card.  The  imprint  should  be  in  the  center  near 
the  upper  border  or  in  the  upper  left  corner. 

It  is  now  customary,  and  requested  by  the  Post 
Office  Department,  that  the  name  and  address  be 
placed  upon  envelopes  to  facilitate  the  prompt 
return  of  undelivered  mail.  For  professional  sta- 
tionery the  imprint  should  be  upon  the  flap  of  the 
envelope  and  of  the  same  character,  either  em- 
bossed or  printed,  as  that  used  for  the  letter-head. 

28 


Stationery. 

The  stamped  envelopes  issued  by  the  Post  Office 
Department  are  not  good  form  for  professional 
use. 

Never  use  for  correspondence  the  ruled  sheets 
that  come  put  up  in  blocks  and  pads.  It  seems 
hardly  necessary  to  mention  these  matters,  but 
from  an  extensive  acquaintance  with  the  corre- 
spondence of  professional  men  it  appears  that  these 
points  are  not  generally  known  or  at  least  not 
observed. 


29 


CHAPTER  VII. 

ADVERTISING. 

The  subject  of  advertising  has  been  a  stumbling 
block  in  the  minds  of  professional  men  for  many^ 
many  years,  and  even  now,  when  the  subject  is 
casually  mentioned,  some  one  is  pretty  sure  to  fig- 
uratively throw  up  his  hands  and  exclaim  that  to 
advertise  is  not  "  ethical."  Such  a  sweeping  state- 
ment indicates  sheer  thoughtlessness  or  else  a  lack 
of  sufficient  information  on  the  subject. 

The  real  purpose  of  advertising  is  "  to  inform 
the  public  concerning  "  some  definite  thing.  This 
certainly  is  neither  morally  nor  ethically  wrong. 
If  there  is  anything  amiss,  then  it  must  be  the  kind 
of  advertising  used  or  the  way  in  which  it  is  em- 
ployed, for  there  are  about  as  many  ways  of  adver- 
tising as  there  are  leaves  on  a  full-grown  tree. 

There  was  a  time,  it  is  true,  when  advertising 
was  employed  almost  exclusively  for  the  purpose 
of  deceiving  and  decoying  gullible  people;  and  con- 
sisted principally  of  extravagant,  untruthful  or 
deceitful  statements,  usually  blazoned  forth  in  a 
vulgar  manner.  This  sort  of  thing  has  been  as 
universally  condemned  by  honest  commercial  men 

30 


Advertjshig. 

as  by  members  of  the  professions.  To-day  the 
men  engaged  In  preparing  advertisements  have  as 
high  Ideals,  are  as  respected  and  as  well  paid  as  any 
class  of  men  engaged  In  earning  a  livelihood. 

The  ever-changing  economic  conditions,  the  cen- 
tralization and  congestion  of  population.  Improved 
transit  facilities,  and  the  migratory  habits  of  well- 
to-do  people  have  served  to  make  advertising  al- 
most a  necessity  for  the  carrying  on  of  a  successful 
business.  This  condition  Is  recognized  and  taken 
advantage  of  by  men  engaged  In  every  kind  of 
business  except  the  professions.  Professional  men 
have  made  progress  In  every  branch  of  their  work 
except  along  purely  business  lines.  Instead  of  giv- 
ing the  business  side  of  their  practice  the  consid- 
eration that  It  deserves,  they  have  been  content  to 
adhere  to  precedents  that  were  established  to  meet 
economic  conditions  existing  fifty  or  more  years 
ago.  Precedent  Is  nearly  always  a  brake  on 
progress. 

In  formulating  the  Code  of  Ethics  of  the  Na- 
tional Dental  Association,  It  has  been  recognized 
that  advertising  w^Ill,  whether  or  no,  enter  Into  the 
business  conduct  of  a  professional  practice ;  and  an 
effort  was  made  to  define  the  methods  of  advertis- 
ing that  are  objectionable,  and  also  to  state  what 
will  be  considered  acceptable  and  ethical.  Note 
very  carefully  the  wording  of  the  paragraph  that 
refers  to  this  subject. 

31 


The  Business  Problems  of  a  Profession, 


Article  II.     Section  2. 

"It  is  unprofessional  to  resort  to  public  adver- 
tisement, cards,  handbills,  posters,  or  signs,  call- 
ing attention  to  peculiar  styles  of  work,  lowness  of 
prices,  special  modes  of  operating,  or  to  claim  supe- 
riority over  neighboring  practitioners;  to  publish 
reports  of  cases  or  certificates  in  the  public  prints, 
to  circulate  or  recommend  nostrums,  or  to  perform 
any  similar  acts.  But  nothing  in  this  section  shall 
be  so  constructed  as  to  imply  that  it  is  unprofes- 
sional for  dentists  to  announce  in  the  public  prints, 
or  by  cards,  simply  their  names,  occupation,  and 
place  of  business,  or  in  the  same  manner  to  an- 
nounce their  removal,  absence  from,  or  return  to 
business,  or  to  issue  to  their  patients  appointment 
cards  having  a  fee  bill  for  professional  services 
thereon." 

The  wording  of  this  paragraph  is  somewhat 
ambiguous  and  has  been  generally  interpreted  to 
mean  a  wholesale  condemnation  of  all  advertising; 
but  a  careful  perusal  will  show  that  it  aims  to  con- 
demn all  advertising  that  could  be  considered  in 
any  way  offensive,  vulgar  or  even  undignified,  and 
mentions  specifically  certain  kinds  of  advertising 
that  are  considered  in  this  category. 

It  would  apparently  seem  unnecessary  to  insert 
such  a  clause  in  a  code  intended  for  the  guidance 

32 


Advertising, 

of  professional  men,  but  the  fact  Is  that  profes- 
sional men  in  general  have  such  a  limited  knowl- 
edge of  good  business  methods  that  when  some  of 
them  find  the  need  of  an  Increasing  income  in  order 
to  keep  going,  Instead  of  carefully  studying  the 
situation,  they  jump  to  the  conclusion  that  adver- 
tising will  solve  the  problem;  and  then  instead  of 
seeking  the  advice  of  an  experienced  advertising 
man,  they  employ  some  cheap  printer  or  sign 
painter  and  use  copy  and  devices  that  any  compe- 
tent advertising  or  commercial  man  would  be 
ashamed  of. 

It  Is  quite  evident  that  professional  services  can- 
not be  properly  advertised  by  the  same  methods 
as  are  used  for  the  sale  of  merchandise,  but  there 
are  many  ways  by  which  a  professional  man  may 
become  known  in  a  community  without  resorting 
to  vulgar  advertising  or  even  to  the  subterfuges 
that  are  so  often  employed.  How  easy  It  is  to  re- 
call Incidences  of  young  doctors  attending  church 
and  occupying  a  prominent  seat  only  to  be  called 
out  In  the  midst  of  the  services,  by  prearrange- 
ment;  or  again  of  their  dashing  out  of  their  offices 
and  driving  furiously  down  the  street  only  to  Idle 
away  some  time  in  an  unfrequented  place  and  then 
driving  rapidly  back  again;  and  the  dentist  who 
makes  It  a  point  to  get  a  drop  of  creosote  or  some 
other  vile-smelling  drug  upon  his  clothes  just  be- 
fore  attending  some   function,   or   else   carries   a 

33 


The  Business  Problems  of  a  Profession. 

mouth  mirror  conspicuously  displayed  In  one  of  his 
pockets. 

This  reminds  me  of  an  Incident  that  occurred  at 
a  dental  convention  recently,  when  a  prominent 
lecturer  at  a  leading  Eastern  dental  college  turned 
and  asked  If  I  happened  to  have  a  mouth  mirror 
In  my  pocket,  as  he  had  forgotten  his.  My  reply 
was  that  I  did  not  consider  a  man's  pocket  a  very 
sanitary  place  to  carry  surgical  Instruments.  Again 
there  are  the  subterfuges  employed  to  get  one's 
name  Into  the  news  columns  of  local  papers  and  to 
have  press  notices  printed — gratis.  These  at- 
tempts are  made  so  often  that  It  Is  no  wonder  that 
newspaper  men  are  disgusted  when  they  hear  pro- 
fessional men  talk  about  Its  being  unethical  to  ad- 
vertise. It  certainly  is  unethical  for  a  man  to  try 
to  get  something  without  paying  for  it. 

The  code  states  suitable  ways  for  professional 
men  to  use  newspaper  advertising,  and  for  which 
regular  advertising  rates  should  be  paid;  but, 
strange  to  say,  these  methods  are  not  generally  em- 
ployed except  In  communities  where  it  would  seem 
unnecessary  from  an  advertising  standpoint.  It 
Is  not  at  all  uncommon  to  find  in  the  local  papers 
of  small  communities  a  space  devoted  to  the  busi- 
ness cards  of  professional  men. 

It  Is  hardly  possible  for  a  professional  man  who 
has  ambition  and  energy,  to  be  located  In  a  town  of 
fifteen   thousand  or  less,   more  than  two  weeks, 

34 


Advertising. 

without  being  quite  generally  talked  about  and  the 
observed  of  all  observers.  This  being  the  case,  it 
would  seem  hardly  necessary  to  resort  to  news- 
paper advertising  in  such  communities.  In  the 
largest  cities,  however,  where  it  is  next  to  impos- 
sible for  a  man  to  become  known  outside  of  a  very 
limited  circle,  these  methods  are  not  employed,  in 
fact  are  frowned  upon  by  the  dental  societies,  and 
the  newspaper  field  is  left  entirely  to  the  men  who 
disgrace  their  calling  by  their  vulgar  methods  and 
untruthful  statements.  In  these  cities  are  large 
numbers  of  people  who  come,  go,  and  move  about 
and  who  have  become  accustomed  to  turning  to 
the  advertising  columns  of  the  daily  papers  to  find 
the  places  that  will  supply  their  needs.  In  doing 
this  they  naturally  see  and  are  influenced  by  these 
vulgar  dental  advertisements  and  soon  come  to 
judge  dentistry  and  dentists  in  general,  by  these 
standards.  The  general  public  does  not  know  and 
cares  less  about  the  codes  and  so-called  "  ethics  " 
of  professional  men.  It  does  know  that  reliable 
and  successful  commercial  men  advertise  and  state 
frankly  what  they  have  to  offer,  and  that  they  may 
be  depended  upon;  and  naturally  they  think  the 
same  must  be  true  of  dental  establishments,  and 
that  those  who  advertise  are  the  ones  that  have 
built  up  a  large  business  from  the  same  causes. 

Every  little  while  there  Is  talk  among  dental 
society  members  about  the  need  of  putting  the 

35 


The  Business  Problems  of  a  Profession, 

"  Dental  Parlors  "  out  of  business,  but  a  way  to 
do  it  is  not  often  suggested.  Newspaper  men,  who 
are  close  observers  of  the  situation,  claim  that  if 
the  good  men  in  the  profession  would  publish  their 
cards  and  other  necessary  information  so  that  the 
general  public  could  note  the  difference  and  be  able 
to  pick  and  choose,  it  would  not  be  long  before 
the  present  vulgar  advertising  matter  would  be  re- 
fused or  withdrawn  and  the  "  Dental  Parlors  " 
forced  into  the  background. 

This  seems  logical,  and  if  carried  out  should 
work  to  the  advantage  of  the  public  as  well  as  to 
the  profession.  Such  a  course  is  fully  sanctioned 
by  the  code  and  therefore  "  ethical." 


36 


CHAPTER  VIII. 

ATTENDANT. 

From  a  business  standpoint  a  young  woman  at- 
tendant Is  an  essential  element  of  a  well-organized 
office.  In  the  care  of  the  reception  and  dressing 
rooms  there  are  many  things  that  will  need  the 
touch  of  a  woman's  hands  In  order  to  keep  them 
looking  neat  and  attractive.  In  the  operating 
room  the  sterlHzatlon  and  general  care  of  the  In- 
struments and  cabinets  can  best  be  done  by  a  well- 
trained  young  woman. 

Time  is  a  professional  man's  chief  asset,  and  he 
should  never  use  It  for  doing  minor  things  that  can 
be  relegated  to  an  assistant  whose  services  are 
worth  but  a  nominal  sum.  In  other  words — if  a 
man's  time  is  worth  five  dollars  an  hour  he  cannot 
afford  to  spend  it  doing  the  things  that  he  can  get 
another  to  do  for  about  five  dollars  a  week.  It  is 
unreasonable  to  expect  patients  to  be  willing  to 
pay  several  dollars  an  hour  for  professional  services 
when  a  large  part  of  that  time  includes  the  doing 
of  petty  things  that  are  merely  incidental  to  the 
operation.  This  is  a  point  that  is  frequently  over- 
looked by  young  practitioners,  and  in  a  spirit  of 

37 


The  Business  Problems  of  a  Profession. 

economy  they  waste  many  minutes  of  a  patient's 
time  and  hours  of  their  own  in  doing  trivial  things. 
This  is  not  only  being  "  penny  wise,"  but  it  is 
poor  business  management  and  tends  to  lengthen 
a  man's  working  hours  into  the  time  when  he 
should  be  getting  rest  and  recreation  to  keep  him- 
self up  to  the  highest  standard  of  efficiency.  When 
a  man  is  not  actually  engaged  In  operating  or 
doing  those  things  which  other  hands  cannot  do 
for  him,  he  should  be  free  to  employ  his  mind  in 
working  out  professional  and  business  details  that 
will  tend  toward  the  betterment  of  his  practice. 

The  attendant  should  be  trained  to  assume  the 
responsibility  of  the  general  care  of  the  offices;  to 
receive  patients  and  look  after  their  comfort;  to 
answer  the  telephone  and  make  appointments; 
take  charge  of  the  supplies,  and  keep  plenty  always 
on  hand;  look  after  the  laundry  and  see  that  the 
chair  is  always  dressed  with  clean  linen;  sterilize 
and  polish  instruments;  assist  during  the  various 
operations;  open  and  close  the  office,  and,  in  fact, 
do  everything  possible  that  will  tend  to  leave  the 
operator's  hands  and  mind  free  to  attend  to  the 
details  of  the  case  before  him. 

In  some  cases  the  keeping  of  the  books  and  rec- 
ords can  be  turned  over  to  her,  but  unless  she  is  to 
be  a  permanent  fixture,  is  close-mouthed  and  thor- 
oughly trustworthy,  it  is  not  well  to  do  this ;  for  it 
is  not  nice  to  have  one's  business  affairs,  the  amount 

38 


Attendant. 

of  the  business  and  one's  income  and  the  financial 
relations  with  patients  the  subject  of  gossip  among 
a  girl's  family  or  friends.  The  keeping  of  the 
books  and  records  can  be  so  simplified  as  to  require 
but  a  few  minutes'  time  each  day  and  a  professional 
man  can  better  afford  to  keep  the  knowledge  of 
these  matters  to  himself. 

Another  point  of  great  importance  is  that  the 
right  sort  of  an  attendant  will  be  an  effectual  check 
against  unseemly  conversation  on  the  part  of  in- 
discreet patients ;  be  a  protection  against  blackmail 
and  an  important  witness  in  case  of  suits  for  mal- 
practice. It  is  extremely  unwise  and  hazardous 
for  a  man  to  perform  any  operation  for  a  stranger, 
particularly  a  woman,  without  an  attendant  being 
present.  The  administration  of  an  anesthetic 
should  never  be  made  except  In  the  presence  of  a 
third  party,  and  if  the  patient  happens  to  be  a 
young  girl  or  a  neurotic  woman  It  will  be  still  bet- 
ter to  have  a  fourth  party  present — one  of  them  to 
be  a  friend  of  the  patient.  Too  great  stress  cannot 
be  laid  on  the  importance  of  these  points.  Many 
men  have  been  fortunate  enough  to  go  through 
their  professional  careers  without  any  unpleasant 
incidents;  but  one  such  is  enough  to  wreck  a  man's 
reputation  and  cling  to  him  for  life. 


39 


CHAPTER    IX. 

FEES. 

The  fee  problem  is  the  most  Important  of  any 
that  a  dentist  has  to  solve,  yet  it  has  received  the 
least  practical  consideration. 

The  plan  of  having  a  fixed  price  per  filling, 
crown,  etc.,  according  to  the  material  used,  origi- 
nated in  the  days  when  dentistry  was  little  more 
than  a  special  trade  and  has  been  handed  down 
from  preceptor  to  student  ever  since.  It  is  an- 
other of  the  things  that  has  become  so  firmly  estab- 
lished through  custom  and  precedent,  that  it  has 
been  almost  exempt  from  discussion  by  profes- 
sional societies,  and  yet,  from  a  truly  professional 
and  business  standpoint,  the  method  is  unreason- 
able and  unjust  to  all  parties  concerned. 

According  to  this  way  of  basing  fees,  the  value 
of  the  materials  used  is  considered  of  more  impor- 
tance than  the  services  rendered.  The  method  Is 
not  elastic,  for  no  allowance  is  made  for  the  kind 
or  position  of  the  cavity,  the  difficulties  of  accurate 
preparation,  the  time  involved,  the  temperament 
of  the  patient,  the  equipment  required,  lost  time 
from  broken  appointments  or  any  of  the  many  de- 

40 


Fees. 

tails  that  are  Involved  in  various  operations.  It 
resolves  Itself  into  purely  a  matter  of  how  many 
fillings  at  a  definite  price  per  filling. 

The  establishing  of  such  a  method  will,  In  the 
long  run,  prove  to  be  a  considerable  disadvantage. 
Let  us  follow  the  workings  of  the  system  and  see 
how  this  may  be. 

A  young  man  selects  a  location  and  begins  prac- 
tice. He  soon  learns  the  scale  of  fees  of  his  neigh- 
boring practitioners  and  adopts  It;  or,  possibly, 
he  may  establish  a  scale  that  Is  somewhat  lower, 
thinking  thereby  to  sooner  gain  a  following.  He 
takes  the  requisite  time  to  perform  each  operation 
to  the  best  of  his  ability  that  he  may  gain  a  repu- 
tation for  good  work  and  attract  more  patients. 
In  time  he  finds  that  his  practice  has  grown  so  that 
he  has  all  that  he  can  comfortably  attend  to  dur- 
ing reasonable  working  hours.  About  this  time 
he  is  also  likely  to  find  that  the  expenses  of  main- 
taining his  office  and  equipment,  together  with  his 
personal  responsibilities  and  expenses,  have  in- 
creased to  such  an  extent  that  a  much  larger  in- 
come is  needed.  If  he  studies  the  situation  he  will 
find  he  is  not  getting  any  better  fees  for  fillings, 
crowns,  etc.,  than  he  did  when  he  first  began 
practice,  although  he  has  more  experience,  better 
judgment  and  Increased  skill,  and  has  kept  pace 
with  the  times  In  methods  and  Improved  equip- 
ment.    So  far,  the  reward  for  his  efforts  has  been 

41 


The  Business  Problems  of  a  Profession, 

an  increase  of  patronage,  but  this  has  brought  him 
to  a  parting  of  the  ways;  he  feels  that  he  must,  and 
is  entitled  to,  increase  his  income,  but  finds  it  can 
only  be  done  at  the  expense  of  either  his  health 
or  his  operations.  He  can  increase  his  working 
hours  and  become  a  veritable  slave,  toiling  days, 
nights,  and  Sundays,  and  be  content  with  having  it 
said  that  he  has  such  a  large  practice  that  he  hasn't 
time  for  a  rest  or  vacation,  and  in  this  way  help 
verify  the  mortality  records  which  say  that  the 
average  period  of  life  for  a  dentist  is  forty-five 
years;  or  else  he  may  cut  corners  on  his  work  and 
become  a  nervous  wreck,  trying  to  do  two  opera- 
tions in  the  time  which  he  formerly  took  for  doing 
one. 

A  method  which  places  a  man  in  such  a  dilemma 
at  the  height  of  his  career  must  surely  be  faulty.  A 
satisfactory  reason  has  never  been  given  for  hav- 
ing a  fixed  fee  for  each  filling,  crown,  etc.  It 
surely  is  not  logical,  nor  is  it  based  upon  any  defi- 
nite idea  of  covering  the  cost  of  the  material,  the 
cost  of  the  operation,  the  maintenance  of  the  office, 
or  of  producing  a  definite  income  for  the  operator. 
The  progress  that  has  been  made  in  the  methods 
of  operating  has  called  for  improved  and  expensive 
equipment,  the  standard  of  office  furnishings  has 
been  very  materially  raised,  the  general  expense  of 
conducting  a  suitable  office  is  continually  increas- 
ing,  the   social    demands   upon   professional  men 

42 


Fees, 

have  become  greater,  but  this  antiquated  method 
makes  no  provision  for  meeting  these  Increased 
expenses.  Many  men  who  have  been  years  In 
practice  are  not  able  to  earn  any  more  In  a  given 
time,  by  this  method,  than  they  did  twenty  years 
ago,  and  yet  their  expenses  have  been  steadily  in- 
creasing. 

About  the  only  purpose  that  this  method  has 
served  has  been  to  fix  In  the  public  mind  the  Idea 
that  a  filling  Is  merely  a  filling,  and  that  It  Is  the 
material  for  which  they  pay,  that  the  time  and  skill 
spent  In  preliminary  treatment  do  not  count;  that 
examinations  are  to  be  made  and  consultations  and 
advice  given  without  charge;  that  when  dentures 
are  to  be  made  the  surgical  removal  of  useless 
teeth  is  to  be  done  free,  and  that  It  Is  only  when 
materials  are  used  that  a  bill  should  be  rendered. 
In  other  words.  It  has  served  to  put  dentistry  on  a 
plane  with  the  dealers  In  merchandise — no  mate- 
rials, no  charge.  The  years  spent  and  expenses  in- 
curred In  acquiring  knowledge  and  skill  count  only 
as  a  means  of  getting  more  trade.  The  man  who 
keeps  abreast  of  the  times,  attends  professional 
meetings  and  clinics,  reads  the  latest  professional 
journals  and  books  and  Is  continually  Improving  his 
technique,  Is  expected  to  sell  his  services  for  the 
same  price  per  filling,  etc.,  as  does  the  other  kind  of 
man;  his  reward  Is  in  the  possibly  increased  number 
of  his  customers.     All  of  which  means  that  if  he 

43 


The  Business  Problems  of  a  Profession, 

wishes  to  Increase  his  income  so  as  to  be  reimbursed 
for  this  outlay,  he  must  labor  an  increased  number 
of  hours  and  thereby  wear  himself  out  that  much 
quicker.  Ah !  but  we  must  not  forget  the  glory  of 
having  such  a  big  practice.  But  glory  is  an  empty 
bubble  when  one  is  worn  out  and  bills  are  pressing. 

This  method  of  charging  for  services  is  unrea- 
sonable and  unjust  to  patients  in  that  it  makes  no 
distinctions.  The  patient  that  aims  to  take  good 
care  of  his  teeth  and  visits  the  dentist  frequently, 
coming  with  a  clean  mouth  and  small  cavities,  is 
expected  to  pay  the  same  price  per  filling  as  the 
one  who  neglects  even  the  simplest  laws  of  hygiene 
and  appears  only  after  long  intervals,  with  a 
mouth  reeking  with  filth  and  with  cavities  so  exten- 
sive and  complicated  as  to  frequently  require  con- 
siderable treatment  before  they  are  in  a  condition 
to  be  properly  filled.  Under  these  same  conditions 
a  crown  is  considered  as  merely  a  crown,  and  no 
distinction  is  made  in  price  between  the  case  where 
the  root  merely  requires  proper  shaping  to  receive 
the  crown  and  the  one  where  extensive  treatment 
is  required,  possibly  involving  the  treatment  and 
cure  of  a  chronic  alveolar  abscess. 

Again,  no  allowance  is  made  for  the  difference 
In  the  temperament  of  patients.  The  patient  who 
Is  always  prompt  in  keeping  engagements,  sits 
quietly  and  allows  the  operator  to  work  quickly 
and  without  unnecessary  Interruptions,  Is  expected 

44 


Fees. 

to  pay  as  much  for  each  operation  as  the  one  who 
Is  generally  late  in  keeping  an  appointment,  restive 
and  fussy,  and  wastes  the  operator's  time  with  un- 
necessary questions,  gossip,  and  general  indecision. 
In  fact,  the  method  considers  a  patient  as  being 
merely  a  patient  and  a  cavity  as  merely  a  hole — 
requiring  a  filling,  at  a  uniform  price,  according  to 
the  kind  of  material  used.  Occasionally  a  slight 
difference  In  price  Is  made — said  to  be  due  to  the 
size  of  the  filling,  but  It  Is  more  apt  to  be  from  a 
sizing  up  of  the  patient.  All  of  which  is  illogical, 
unreasonable,  and  unjust. 

However,  there  Is  a  method  of  basing  fees  that 
has  none  of  these  objections  and  which  seems  to  be 
perfectly  logical,  reasonable  and  just  to  all  parties 
concerned,  and  that  is  founded  on  good  business 
principles.  This  method  will  be  considered  in 
Chapter  X. 


45 


CHAPTER    X. 

ESTIMATING   THE    COST. 

Probably  no  other  class  of  men  carrying  on 
business  know  so  little  about  the  general  principles 
underlying  business  transactions  as  professional 
men. 

In  all  lines  of  general  business  It  Is  considered 
essential  that  the  cost  of  the  thing  to  be  disposed 
of  shall  be  known  before  fixing  the  selling  price, 
and  yet  It  Is  customary  for  professional  men  to  es- 
tablish a  scale  of  fees  for  their  services  without 
having  any  definite  Idea  about  what  It  actually 
costs  them  to  render  the  service,  nor  Is  this  scale 
based  upon  any  plan  for  producing  a  definite 
Income. 

A  professional  man  usually  adopts  the  scale  of 
fees  that  he  finds  already  established  In  the  com- 
munity where  he  begins  practice  and  continues  to 
render  his  services  at  the  same  rate  during  the  rest 
of  his  career.  This  Is  particularly  true  of  dentists. 
Most  of  them  are  even  now  rendering  their  serv- 
ices for  the  same  remuneration  that  was  established 
many,  many  years  ago.  This  Is  In  spite  of  the  fact 
that  the  cost  of  obtaining  a  professional  education 

46 


Estimating  the  Cost. 


'^» 


is  now  ven^  much  greater,  and  the  general  cost  of 
living  and  the  maintenance  of  a  practice  have  very 
materially  increased,  to  say  nothing  of  the  progress 
that  has  been  made  In  dental  science  and  the  In- 
creased cost  of  the  services  rendered. 

The  excuse  has  been  that  the  cost  of  professional 
services  cannot  be  estimated  as  can  that  of  mer- 
chandise, and  so  the  fee  must  be  based  on  what  the 
dentist  thinks  the  patient  can  or  will  pay.  It  has 
been  quite  the  general  impression  that  there  was 
no  method  by  which  the  cost  of  dental  services 
could  be  estimated  except  by  possibly  considering 
the  first  cost  of  the  materials  used.  As  a  conse- 
quence, many  men  have  labored  under  the  delusion 
that  unless  materials  were  used  In  connection  with 
an  operation  there  was  no  direct  expense  attached; 
and  also  that  If  there  was  any  time  during  office 
hours  when  a  dentist  was  not  engaged  In  earning 
something,  he  was  not  suffering  any  loss.  These 
Ideas  are  certainly  erroneous,  for  a  dentist  Is  under 
a  direct  expense  every  minute  of  his  office  hours, 
and  besides,  there  is  a  method  of  determining  what 
this  expense  may  be. 

In  a  commercial  business  the  selling  price  of  an 
article  is  fixed  with  reference  to  its  actual  cost  to 
the  retailer.  This  is  determined  by  adding  to  the 
first  cost  of  the  article  a  given  percentage  of  the 
cost  of  distribution,  the  interest  on  the  capital  in- 
vested, and  a  certain  allowance  for  covering  profit 

47 


The  Business  Problems  of  a  Profession, 

or  loss.  The  term  "  cost  of  distribution  "  is  a  gen- 
eral one  and  covers  the  cost  of  maintaining  the 
necessary  establishments,  insurance,  the  salaries  of 
the  proprietor  and  employees,  and  any  and  every 
item  that  has  any  bearing  upon  the  cost  of  conduct- 
ing the  business. 

A  similar  plan  may  be  used  for  determining  the 
cost  of  maintaining  a  dental  practice,  and  by  know- 
ing the  cost  it  will  be  possible  to  formulate  a  scale 
of  fees  that  will  be  equitable. 

In  applying  this  plan  the  first  item  to  be  consid- 
ered will  be  the  capital  invested.  The  first  invest- 
ment of  capital  will  be  for  the  obtaining  of  a  pro- 
fessional education.  The  amount  involved  may  be 
determined  by  figuring  the  cost  of  college  tuition 
and  fees,  of  books,  instruments  and  supplies  re- 
quired, of  board  and  general  living  expenses  during 
the  college  years,  and  the  amount  of  lost  earnings 
during  the  period.  Five  thousand  dollars  has  been 
considered  a  fair  estimate  of  the  total  cost  of  ob- 
taining a  professional  education  under  present  con- 
ditions, and  for  the  purposes  of  illustration,  this 
sum  will  be  taken  as  the  amount  of  capital  thus 
invested. 

The  next  investment  will  be  for  the  equipping  of 
a  suitable  office.  The  average  office  having  mod- 
ern furnishings  and  equipment  will  probably  in- 
ventory at  about  $2,000.  This  gives  a  total  of 
$7,000  as  representing  the  amount  of  capital  that 

48 


Estimating  the  Cost. 

Is  Invested  In  the  business.  If  this  amount  of 
money  were  Invested  In  mortgages  or  In  securi- 
ties It  would  yield  an  Income  of  about  six  per  cent, 
and  It  should  at  least  yield  the  same  amount  from 
having  been  Invested  In  the  dentist's  own  business. 
The  Interest  on  the  Investment  at  six  per  cent 
should  be  considered  as  one  of  the  fixed  expenses 
of  the  business. 

The  next  point  to  be  considered  In  applying  this 
plan  will  be  the  estimated  expenses  of  conducting 
the  business  per  annum.  The  first  Item  will  be  the 
necessary  sum  required  to  cover  the  depreciation 
and  cost  of  renewal  of  the  furniture  and  equip- 
ment. The  serviceable  life  of  such  things  Is  usu- 
ally considered  as  being  about  ten  years,  and  It  Is 
customary  to  set  aside  ten  per  cent  of  their  original 
cost  each  year,  to  cover  the  expense  of  their  replace- 
ment. Another  Item  will  be  the  amount  of  the 
premiums  on  an  Insurance  policy,  taken  on  the  life 
of  the  operator  and  made  payable  to  the  business 
(estate).  The  amount  of  the  policy  should  be 
governed  by  the  amount  of  business  that  the  oper- 
ator can  produce;  that  Is  to  say.  If  the  gross  busi- 
ness amounts  to  $5,000  then  the  Insurance  may  be 
for  a  like  amount;  because  this  will  represent  his 
producing  value  to  the  business.  This  Insurance 
policy  becomes  a  collateral  of  the  business  and  will 
be  found  particularly  valuable  In  adjusting  the  af- 
fairs in  case  of  such  an  emergency  as  the  sudden 

49 


The  Business  Problems  of  a  Profession. 

death  of  the  operator,  and  will  also  be  found  an 
advantage  in  securing  or  establishing  a  business 
credit. 

The  next  items  will  be  the  general  expenses  con- 
nected with  the  carrying  on  of  the  business.  First 
of  these  will  be  the  fire  insurance  premium,  for  it 
is  always  wise  to  be  protected  against  loss.  Fol- 
lowing this  will  come  the  rent,  heat,  light,  janitor 
services,  telephone,  etc.  The  next  in  order  will  be 
the  estimated  amount  of  dental  supplies  required 
during  the  year.  After  this  there  will  be  the  yearly 
salary  of  the  young  woman  attendant.  The  next 
important  item  to  be  considered  will  be  the  salary 
for  the  dentist  himself.  At  this  point  it  may  be 
well  to  state  that  there  is  one  important  thing  that 
should  be  fully  understood  and  kept  constantly  in 
mind  during  all  business  transactions,  and  that  is : 
In  dealing  with  a  practice  from  a  business  stand- 
point the  practitioner  should  consider  himself  and 
the  practice  as  two  separate  and  distinct  parties, 
and  his  personal  relation  to  the  business  as  merely 
that  of  an  employee.  This  is  one  of  the  essential 
features  of  good  business  management. 

Regarding  the  amount  of  salary  that  the  dentist 
will  be  entitled  to — while  this  must  be  governed 
very  largely  by  the  amount  of  business  he  can  pro- 
duce, yet  it  will  be  necessary  for  him  to  look  ahead 
and  provide  for  an  income  sufficient  to  cover  his 
personal    requirements.      A   young  and   inexperi- 

50 


Estimating  the  Cost. 

enced  operator  will  not  be  able  to  command  as 
much  business  as  an  older  practitioner  and  should 
not  expect  to  draw  as  much  salary  from  his  busi- 
ness, but  he  should  try  to  plan  his  business  affairs 
so  that  as  his  experience  and  skill  Increase,  he  will 
be  enabled  to  draw  an  increased  salary  each  year. 

Still  another  Important  Item  will  be  the  Inci- 
dental expense.  This  account  should  cover  the 
cost  of  all  stationery,  postage,  minor  office  sup- 
plies and  everything  that  In  any  way  pertains  to  the 
general  maintenance  of  the  office  or  the  Improve- 
ment of  the  dentist  as  an  operator.  By  this  Is 
meant  all  society  dues,  the  expenses  connected  with 
the  attendance  of  clinics,  study  courses,  etc.,  the 
cost  of  books,  subscriptions  to  dental  journals, 
books  and  magazines  for  the  reception-room  table, 
etc.  These  items  are  generally  overlooked  in  mak- 
ing up  the  expense  account  and  yet  they  are  all 
legitimate  charges,  as  they  are  for  the  betterment 
of  the  practice. 

When  this  schedule  has  been  put  together  It  will 
appear  somewhat  as  follows: 

Original  Investment. 

Professional  education $5,000.00 

Furnishings  and  equipment 2,000.00 


Total. $7,000.00 

51 


The  Business  Problems  of  a  Profession. 

Estimated  Expenses  for  the  Year, 

Interest  on  investment $420.00 

Depreciation  and  replacement 200.00 

Life  insurance  premium 

Fire  insurance  premium 

Rent    

Heat,  light,  janitor  service 

Telephone,  etc 

Dental  supplies    

Attendant's  salary 

Personal  salary 

Incidental  expenses 


Total 

In  making  up  the  schedule  of  estimated  yearly 
expense,  figures  have  not  been  carried  out  after  the 
various  items,  for  they  will  vary  considerably  ac- 
cording to  the  community,  the  kind  of  practice  and 
conditions  generally;  but  if  the  practitioner  who 
desires  to  use  this  plan  will  fill  in  the  amounts  with 
his  own  figures  he  will  be  enabled  to  determine  the 
approximate  cost  of  conducting  his  practice. 

With  the  amount  of  the  total  yearly  expense 
known,  the  next  problem  is  to  determine  how  this 
may  be  apportioned  so  that  each  working  day  may 
bear  its  own  quota. 


521 


CHAPTER    XL 

TIME. 

The  practice  of  dentistry  differs  from  that  of 
other  professions  In  the  nature  of  the  work  and 
the  way  services  are  rendered.  A  dentist  must 
have  a  general  knowledge  of  medical  science  and 
be  familiar  with  parts  of  many  of  the  arts  and 
mechanical  trades,  yet  with  all  this  his  earning 
power  depends  almost  entirely  on  the  exercises  of 
fingercraft.  Instrumentation  Is  a  feature  of  all  the 
operations,  and  time  Is  an  Important  factor  In  their 
proper  performance.  The  amount  of  time  re- 
quired Is  governed  very  largely  by  the  nature  of 
the  operation  and  the  general  conditions,  such  as 
the  temperament  of  the  patient,  accessibility,  etc. 

This  being  the  case.  It  Is  plainly  seen  that  time  Is 
an  Important  factor  In  all  operations,  that  It  very 
largely  determines  the  number  that  may  be  per- 
formed and  thus  has  a  very  material  bearing  on 
the  earning  power  of  the  operator.  How  much 
time,  then,  during  the  course  of  a  year,  will  be  at 
the  command  of  a  practitioner  who  desires  to  re- 
tain his  health  and  vitality,  maintain  himself  at  the 
highest  standard  of  mental  and  physical  efficiency 

53 


The  Business  Problems  of  a  Profession. 

for  his  work,  and  also  have  time  to  enjoy  the  pleas- 
ures and  recreation  of  cultured  people,  in  which  to 
earn  a  sufficient  amount  to  cover  the  yearly  expense 
and  make  a  reasonable  profit  besides? 

This  may  be  determined  by  a  process  of  elimina- 
tion. First  to  be  considered  will  be  the  question 
of  working  on  Sundays  and  holidays.  While  there 
may  be  good  reasons  why  physicians  should  be  on 
duty  on  Sundays  and  holidays  there  are  practically 
none  why  dentists  should  be. 

Emergencies  may  arise  at  such  times  requiring 
the  services  of  a  dentist  in  order  to  relieve  suffer- 
ing, but  it  certainly  is  not  necessary  for  the  dentist 
to  keep  regular  office  hours  on  these  days  in  order 
to  meet  these  emergencies. 

The  physician's  work  differs  from  that  of  the 
dentist  in  that  a  large  part  of  it  consists  of  making 
calls  which  take  him  out  into  the  fresh  air  and  sun- 
shine, where  there  is  an  everchanging  scene  to  rest 
his  eyes,  mind,  and  nerves,  and  thus  he  is  enabled 
to  stand  the  strain  of  long  hours  for  a  continuous 
number  of  days.  The  work  of  the  dentist  necessi- 
tates his  spending  his  working  hours  within  the 
confines  of  a  small  room,  operating  by  a  steady 
light  from  which  the  direct  rays  of  the  sun  are  usu- 
ally eliminated.  The  effect  of  such  a  condition  is 
a  tremendous  strain  upon  the  vitality  and  nervous 
energy  of  the  one  subjected  to  it.  It  therefore  fol- 
lows that  the  dentist  of  all  men  is  the  one  who 

54 


Time, 

should  embrace  every  opportunity  for  rest  and  rec- 
reation in  the  fresh  air  and  sunshine. 

The  fact  probably  is  that  most  dentists  who 
have  established  office  hours  on  Sundays  and  holi- 
days do  so  from  a  mercenary  rather  than  a  hu- 
manitarian spirit.  The  old  plan  of  a  fixed  price 
for  the  different  kinds  of  filling,  etc.,  has  made  it 
seem  necessary  to  work  long  hours  and  on  Sun- 
days, that  a  dentist  may  increase  his  income.  It 
is,  however,  really  unnecessary  for  a  dentist  to 
have  office  hours  on  Sundays  and  holidays,  and  it 
is  never  good  business  policy.  These  days  should 
therefore  be  deducted;  thus  eliminating  sixty  days 
in  a  year. 

The  next  to  be  considered  is  the  question  of  a 
vacation.  How  much  time  should  be  taken  for  a 
complete  change  and  rest  by  one  who  is  engaged  in 
such  a  confining  and  nerve-exhausting  occupation 
as  dentistry?  It  has  been  well  said  by  a  profes- 
sional man  that  he  could  do  twelve  months'  work  in 
eleven,  but  that  he  could  not  do  it  in  twelve  and  do 
it  satisfactorily.  If  a  dentist  wishes  to  maintain 
for  a  long  period  a  high  standard  of  mental  and 
physical  efficiency,  then  he  must  take  sufficient  time, 
whenever  needed,  to  thoroughly  recuperate,  and  he 
must  also  have  an  opportunity  to  take  an  interest 
in  other  things,  so  as  not  to  become  narrow-minded 
and  self-centered. 

Four  weeks'  rest  seems  little  enough  for  a  pro- 

55 


The  Business  Problems  of  a  Profession. 

fessional  man.  While  some  men  would  prefer  to 
take  the  four  weeks  consecutively,  there  will  be 
others  who  will  find  it  more  beneficial  or  convenient 
to  divide  the  time.  One  good  plan  is  to  take  a 
week  in  the  spring  and  another  in  the  autumn,  as 
they  will  then  come  at  a  time  when  one  is  working 
hard  and  most  needs  the  change.  The  other  two 
weeks,  or  more,  may  be  taken  in  mid-surtimer 
when  business  is  slack  and  most  people  are  away. 

Allowing  four  weeks  for  a  vacation  period,  there 
will  be  practically  ninety  days,  all  told,  eliminated 
from  the  year,  leaving  two  hundred  and  seventy- 
five  days  within  which  to  earn  sufficient  money  to 
meet  all  the  expenses  and  provide  something  for 
old  age  and  the  proverbial  "  rainy  day." 

Next  should  be  determined  the  available  number 
of  working  hours  in  each  day.  As  most  dental 
operations  require  the  undivided  attention  of  the 
operator  for  periods  of  an  hour  or  more,  this  pro- 
tracted concentration  becomes  a  very  considerable 
nervous  strain  and  tends  to  limit  the  amount  of 
work  that  can  be  safely  undertaken,  if  health  and 
vitahty  are  to  be  maintained.  A  business  day  of 
six  or  seven  hours  is  all  that  a  professional  man 
should  undertake,  and  if  the  office  hours  are  ar- 
ranged to  be  from  9  A.M.  to  4  or  5  P.M.,  they  will 
cover  the  time  that  is  most  suitable  and  the  period 
when  the  light  is  the  best.  It  is  poor  business  pol- 
icy and  decidedly  unwise  from  a  health  standpoint 

56 


Time, 

to  have  evening  office  hours  or  to  do  work  by  an 
artificial  light,  except  In  cases  of  emergency. 

If  the  office  hours  are  arranged  to  cover  a 
period  of  seven  hours  it  will  be  found,  owing  to 
interruptions  and  the  time  lost  while  changing  pa- 
tients, that  there  will  be  but  five,  or  possibly  six, 
hours  that  are  occupied  with  work  for  which  a 
charge  can  be  made. 

Given  the  total  amount  of  the  fixed  and  esti- 
mated expenses  for  the  year,  together  with  the 
number  of  business  days  decided  upon.  It  is  but  a 
simple  matter  to  determine  the  proportionate  ex- 
pense for  each  day.  If  this  amount  is  again  di- 
vided by  the  number  of  actual  earning  hours  it  will 
give  the  expense  per  hour. 

Thus  it  is  shown  that  time  is  a  very  Important 
factor  to  a  dentist,  as  each  hour  represents  a  defi- 
nite amount  of  expense  that  must  be  met  in  order 
to  conduct  a  practice  successfully. 


57 


CHAPTER   XIL 

THE    HOUR    FEE. 

Having  found  that  It  does  cost  a  definite 
amount  per  hour  to  maintain  a  practice  and  know- 
ing what  that  amount  is,  the  next  step  is  to  fix  upon 
a  fee  that  will  be  sufficient  to  cover  this  expense 
and  yield  a  reasonable  profit.  Such  a  procedure  is 
essential  for  the  successful  conduct  of  a  business; 
is  perfectly  legitimate  and  fair  to  all  parties  con- 
cerned. 

In  determining  what  this  amount  (the  fee) 
shall  be,  it  is  necessary  to  take  into  consideration 
and  make  allowances  for  lost  time,  uncollectable 
accounts,  etc.  As  a  general  proposition  twenty-five 
per  cent  may  be  considered  a  fair  amount  to  repre- 
sent such  losses  and  another  twenty-five  per  cent 
may  represent  a  reasonable  profit.  These  percen- 
tages will  vary,  however,  according  to  the  indi- 
vidual practice. 

The  actual  cost  plus  fifty  per  cent  will  represent 
the  amount  that  must  be  earned  and  charged  each 
hour  in  order  to  meet  expenses,  yield  an  income 
and  profit,  and  have  a  successful  business.  Know- 
ing now  that  a  definite  amount  must  be  charged  for 

58 


The  Hour  Fee, 

each  hour  or  fraction  thereof,  It  becomes  essential 
that  such  a  degree  of  skill  and  speed  In  operating 
be  developed  as  will  make  It  possible  to  render  a 
fair  amount  of  service  In  return  for  this  fee.  It  Is 
not  called  for,  nor  Is  It  wise,  for  an  operator  to 
work  at  race-horse  speed,  but  the  work  should  pro- 
ceed systematically  and  steadily  at  a  rate  that  will 
neither  excite  nor  overtire  the  patient;  and  the  op- 
erating equipment  should  be  so  arranged  that  no 
time  need  be  lost.  Sufficient  time  should  be  taken 
to  attend  to  all  the  details  of  the  case  in  hand,  no 
matter  what  it  may  be,  and  when  it  Is  finished  the 
amount  of  the  fee  will  be  governed  by  the  amount 
of  time  that  has  been  devoted  to  that  patient. 

In  this  way  the  patient  only  pays  for  what  he 
gets  and  the  operator  Is  paid  for  all  that  he  does. 


59 


CHAPTER  XIII. 

APPOINTMENTS. 

In  a  practice  that  is  conducted  on  the  time  basis 
it  is  not  desirable  to  have  patients  dropping  in  with 
the  expectation  of  receiving  immediate  attention  or 
to  have  the  reception  room  filled  with  waiting  peo- 
ple. It  is  far  better  to  have  it  understood  that  all 
operations  are  performed  by  appointment  only. 
One  or  two  hours  a  day  should  be  set  aside  for 
consultations,  examinations  and  emergency  work, 
and,  as  far  as  possible,  such  work  should  be  at- 
tended to  during  those  hours.  When  patients  are 
to  return  for  some  specific  work  a  definite  appoint- 
ment should  be  made  for  a  stated  time,  and  it 
should  be  thoroughly  impressed  upon  them  that  a 
certain  amount  of  time  has  been  reserved  for  them 
exclusively  and  that,  if  through  any  unforeseen  cir- 
cumstance they  find  themselves  unable  to  keep  the 
engagement,  suitable  notice  must  be  given  or  else 
a  loss  will  be  entailed  for  which  they  will  be  ex- 
pected to  pay.  If  a  patient  makes  an  engagement 
under  these  conditions,  it  becomes  a  legal  contract 
and  will  be  held  as  such  if  it  should  become  neces- 
sary to  go  to  court  in  order  to  collect  an  account. 

60 


Appointments. 

In  making  these  appointments  enough  time 
should  be  reserved  for  each  one  to  permit  of  meet- 
ing any  conditions  that  may  arise  and  of  giving 
proper  attention  to  all  the  details  of  the  case.  It 
will  be  found  that,  as  a  rule,  about  four  or  five  such 
appointments  a  day  will  be  all  that  can  be  taken 
care  of  during  suitable  office  hours.  When  all  the 
time  for  one  day  has  been  allotted,  fill  the  hours  of 
the  next,  and  the  next,  and  so  on,  as  far  ahead  as 
the  practice  may  warrant.  Do  not  increase  the 
working  hours  of  any  day  or  days  just  because  of 
the  number  of  patients  asking  for  time,  but  assign 
them  a  future  hour  in  the  order  In  which  they  come. 
The  reason  and  policy  of  this  will  be  discussed  In 
Chapter  XIX. 

With  regard  to  broken  appointments,  It  is  well 
to  have  It  understood  that  all  lost  time  will  be 
charged  for,  but  there  are  times  and  circumstances 
when  It  may  not  be  advisable  to  adhere  too  strictly 
to  this  rule.  Unless  some  such  understanding  Is 
had  with  patients  they  will  get  the  idea  that  an 
appointment  not  kept  does  not  entail  any  loss,  and 
form  the  habit  of  needlessly  breaking  appoint- 
ments. 

As  a  general  thing  the  full  charge  for  all  time 
reserved  should  be  made  in  case  of  a  broken  ap- 
pointment ;  but  there  will  be  times  when  It  Is  advis- 
able to  make  only  a  portion  of  this  charge.  The 
patient  should  then  be  given  to  understand  that 

6i 


The  Business  Problems  of  a  Profession. 

this  is  not  the  general  rule  but  that  an  exception 
has  been  made  in  his  case.  When  charging  for  a 
broken  appointment  some  allowance  should  be 
made  if  it  has  been  possible  to  fill  the  time  or  some 
portion  of  it. 

If  a  patient  comes  in  five,  ten  or  fifteen  minutes 
late  and  the  operator  has  been  ready  and  waiting 
during  that  time,  the  charge  should  be  made  for 
the  full  time  just  the  same.  If  the  patient  is  a 
half  hour  late  he  should  be  made  to  lose  the  entire 
engagement  and  other  appointment  be  given  him, 
and  a  full  charge  made  for  the  lost  time  unless  a 
very  satisfactory  excuse  be  given. 

An  operator  should  always  try  and  be  as  prompt 
in  keeping  appointments  with  his  patients  as  he 
expects  them  to  be  with  him. 


62 


CHAPTER    XIV. 

RECEPTION    OF    PATIENTS. 

The  way  a  person  is  received  in  an  office 
may  have  considerable  bearing  upon  his  decision 
whether  to  become  or  remain  a  patient  or  not. 

It  should  be  the  duty  of  the  young  lady  attend- 
ant to  answer  the  door  as  promptly  as  possible, 
learn  the  wishes  of  the  caller  and  make  him  feel 
at  ease  until  the  operator  has  an  opportunity  to 
speak  with  him.  In  the  case  of  agents,  traveling 
salesmen  or  a  patient  who  merely  wishes  an  ap- 
pointment, the  attendant  will  probably  be  able  to 
attend  to  the  business  without  disturbing  the  oper- 
ator; if,  however,  it  should  be  a  patient  really  de- 
sirous of  speaking  with  the  doctor,  or  a  brother  pro- 
fessional man,  he  should  be  announced  at  once  and 
word  returned  how  soon  the  operator  will  be  able 
to  speak  with  him.  It  will  mean  a  good  deal  some- 
times, if  the  operator  will  but  merely  step  to  the 
door  of  the  reception  room  and  himself  tell  the 
patient  how  soon  he  will  be  at  liberty  to  talk  with 
him. 

It  is  bad  policy  to  leave  anyone  to  cool  their 

63 


The  Business  Problems  of  a  Profession. 

heels  in  a  reception  room  not  knowing  whether 
they  are  to  be  kept  waiting  five  minutes  or  an  hour. 
Their  time  may  be  quite  as  valuable  as  the  doc- 
tor's, and  they  might  prefer  to  spend  it  elsewhere, 
particularly  if  their  business  with  him  would  take 
but  a  moment  to  transact.  In  the  case  of  a  brother 
professional  man,  it  is  but  courtesy  that  he  should 
be  seen  at  the  earliest  possible  moment  and  not  be 
detained  one  minute  longer  than  necessary.  If  it 
happens  that  the  operator  is  really  engaged  upon 
some  work  that  cannot  be  left  for  sometime,  it  is 
better  that  the  attendant  should,  from  time  to  time, 
speak  to  the  person  waiting  and  inform  him  of  the 
circumstances  and  that  the  doctor  regrets  keeping 
him  waiting  so  long  and  that  he  will  be  ready  to 
see  him  soon. 

Sometimes  a  professional  man  gets  the  idea  if 
he  keeps  people  waiting  for  a  long  time  before 
speaking  with  them,  that  they  will  be  impressed 
with  the  idea  that  he  is  an  important  and  a  very 
busy  man.  Well,  it  may,  but  it  certainly  is  not 
very  courteous. 

It  may  not  be  amiss  to  mention  one  person's  ex- 
perience in  two  dental  offices  in  the  same  town. 
This  person  had  occasion  to  call  upon  a  dentist  and 
accepted  the  invitation  upon  the  door  to  walk  in. 
There  was  no  one  in  sight  to  receive  him,  although 
a  voice  could  be  heard  in  a  distant  room.  He  took 
a  seat  and  waited — and  waited.    At  the  expiration 

64 


Reception  of  Patients. 

of  one-half  hour  he  became  disgusted  and  walked 
out.  During  the  entire  time  there  had  been  noth- 
ing to  indicate  to  him  that  his  presence  was  even 
known,  but  being  a  gentleman  he  did  not  feel  called 
upon  to  make  a  disturbance  in  order  to  attract 
some  one's  attention.  He  went  from  this  office  to 
another,  up  a  flight  of  stairs  Into  a  hall  in  the  cen- 
ter of  a  number  of  living  rooms  with  the  doors  all 
open.  While  debating  which  door  to  enter  he  no- 
ticed that  he  was  being  observed  by  a  young 
woman  in  one  of  the  front  rooms,  but  she  gave  no 
sign  that  she  saw  him  and  quickly  disappeared  be- 
hind a  screen.  It  was  afterwards  learned  that  this 
was  the  operating  room  and  that  she  was  the  at- 
tendant. The  reception  room  was  finally  discov- 
ered and  other  people  found  waiting.  When  one 
patient  was  dismissed  another  one  was  signalled  to, 
from  a  passageway  leading  through  to  the  oper- 
ating room,  but  neither  the  attendant  nor  the  doc- 
tor came  Into  the  reception  room  nor  where  either 
could  see  who  was  waiting,  or  speak  to  them.  The 
doctor's  attention  was  finally  attracted  by  the 
stranger  taking  a  position  directly  in  front  of  this 
passageway  so  that  he  had  to  be  seen. 

Not  very  good  business  management  In  either 
case,  was  it? 


65 


CHAPTER   XV. 

RECORDS   OF   OPERATION. 

It  almost  goes  without  saying  that  a  record 
should  be  kept  of  all  operations  and  the  details 
connected  therewith — and  the  more  complete  they 
are  the  better.  Many  methods  have  been  devised 
and  there  are  innumerable  "  card  systems  "  on  the 
market  for  this  purpose.  It  cannot  be  rightfully 
said  that  any  one  ''  system  "  is  preeminently  better 
than  the  others,  for  they  all  have  some  good  fea- 
tures, and  it  is  merely  a  matter  of  adopting  the  one 
that  best  suits  the  individual  requirements.  For 
general  purposes,  however,  a  card  system  is  better 
than  a  book  record. 

With  cards,  it  is  possible  to  so  divide  and  ar- 
range them  that  while  any  record  will  be  always 
available  only  the  active  ones  need  be  handled 
and  the  open  accounts  can  be  so  segregated  as  to 
greatly  facilitate  the  rendering  of  bills  and  the 
keeping  track  of  slow  pay  accounts.  A  card  that 
has  a  space  for  recording  general  information  re- 
garding the  patient,  a  good  diagram  of  the  sur- 
faces of  the  teeth  and  sufficient  space  for  the 
charges  and  credits  will  serve  the  purpose  very 

66 


Records  of  Operation. 

well — anything  more  than  that  adds  to  the  time 
and  labor  required  to  keep  up  the  records.  Always 
have  In  mind  that  a  good  system  Is  Intended  to 
simplify — not  to  complicate. 

So  many  ways  have  been  devised  for  recording 
the  different  operations  In  connection  with  the  dia- 
grams that  It  Is  out  of  the  question  to  give  space 
to  a  description  of  them.  Any  scheme  of  marks 
that  can  be  readily  understood  at  a  glance  will 
serve  the  purpose,  and  such  schemes  are  usually 
best  developed  by  the  individual  to  suit  his  own 
needs. 

As  time  goes  on  these  records  will  become  the 
most  valuable  accessory  In  the  office,  for  In  case  of 
a  fire  or  other  accident,  practically  everything  else 
could  be  replaced  without  difficulty;  but  if  these 
records  are  destroyed  they  never  could  be  entirely 
replaced  and  this  would  be  a  serious  handicap  when 
beginning  practice  again.  For  this  reason  the 
cards  should  be  of  such  a  size  and  kept  in  a  recep- 
tacle that  will  permit  of  their  being  quickly  re- 
moved to  a  place  of  safety  should  an  emergency 
arise  during  the  day,  and  of  their  being  placed  In 
a  fireproof  safe  or  vault  when  not  in  use. 

The  best  time  for  filling  out  these  records  is 
when  the  patient  leaves  the  chair  immediately  after 
the  operation.  The  patient  may  then  be  asked  to 
step  to  the  desk  in  another  part  of  the  room  (It 
would  be  out  of  place  In  the  reception  room),  and 

67 


The  Business  Problems  of  a  Profession. 

the  entire  record  made  out  in  his  presence;  in  this 
way  mistakes  are  likely  to  be  avoided,  and  the  pa- 
tient will  have  an  opportunity  to  raise  any  ques- 
tions he  may  desire.  This  is  also  the  time  to  dis- 
cuss charges,  terms,  payments,  etc.  More  will  be 
said  in  reference  to  this  particular  feature  in  a  sub- 
sequent chapter.  It  is  important  that  these  records 
should  be  made  at  this  time  and  on  the  permanent 
chart,  for  should  it  become  necessary  to  bring  suit 
to  collect  an  account,  the  courts  only  accept,  as 
good  evidence,  the  original  records  made  at  the 
time  of  the  operation. 

The  few  minutes  required  for  this  work  will  not 
be  lost  even  in  a  busy  practice,  for  while  it  is  being 
done  the  attendant  should  be  getting  the  operating 
equipment  ready  for  the  next  patient.  Changing 
the  linen  on  the  chair,  sterilizing  the  instruments, 
and  getting  everything  spick  and  span  in  the  pres- 
ence of  the  retiring  patient  is  a  good  plan,  for  it 
gives  that  patient  an  opportunity  of  seeing  the  care 
that  is  exercised  and  tends  to  increase  confidence. 
The  succeeding  patient  should  not  be  allowed  to 
enter  the  operating  room  until  everything  Is  In  per- 
fect order.  Many  a  good  patient  has  been  lost 
from  having  been  asked  to  sit  in  an  untidy  chair, 
with  a  litter  of  instruments  used  in  previous  oper- 
ations all  about,  and  by  having  the  operator  forget 
and  pick  Instruments  out  of  the  mess  and  begin  to 
use  them. 

68 


CHAPTER  XVI. 

JOURNAL  AND  LEDGER  RECORDS. 

It  Is  essential  that  a  complete  record  of  all 
transactions  be  kept,  In  order  that  the  conditions 
of  the  business  may  be  known  at  any  time.  A  day- 
book Is  the  proper  place  for  recording  such  Items 
as  these. 

In  keeping  such  a  record  there  are  four  funda- 
mental accounts,  the  figures  of  which  should  be 
readily  at  hand  In  order  to  conduct  the  practice  on 
a  sound  business  basis.  These  are:  i.  The  amount 
of  business  done.  2.  The  cash  received.  3.  The 
expense  Incurred.  4.  The  amount  of  money  with- 
drawn from  the  business  for  personal  use. 

A  simple  method  of  separating  and  tabulating 
these  Items  Is  to  use  a  day-book  that  Is  ruled  with 
four  or  more  columns  Instead  of  the  customary 
two  at  the  right  hand  side  of  the  page.  A  column 
Is  reserved  for  the  figures  of  each  of  the  accounts 
that  It  Is  desired  to  keep.  As  the  Items  for  the 
day  are  entered,  the  figures  are  placed  In  the 
proper  columns  and  the  footings  carried  forward 
from  page  to  page  until  the  end  of  the  month  is 

69 


The  Business  Problems  of  a  Profession. 

reached,  when  the  totals  are  figured  up  and  bal- 
anced. These  figures  may  be  supplemented  by 
bringing  forward  the  totals  of  the  preceding 
months,  thus  giving  the  amounts  for  the  year  up 
to  that  date. 

Putting  the  figures  together  In  this  way  makes 
It  easy  to  ascertain  the  condition  of  the  business  at 
any  time ;  make  comparisons  with  other  years,  day 
by  day  or  month  by  month;  to  note  how  the  cash 
receipts  compare  with  the  gross  business;  how  the 
expense  account  compares  with  the  net  business; 
the  exact  amount  that  Is  being  withdrawn  from 
the  business  for  personal  use,  so  that  one's  private 
affairs  may  be  regulated  accordingly;  and  to  know 
whether  the  practice  is  making  a  fair  profit  or  a 
business  loss.  In  keeping  the  expense  account  It 
will  be  found  that  there  will  be  continual  expendi- 
tures of  small  amounts  for  minor  supplies,  such  as 
postage,  etc.,  and  it  is  unnecessary  to  write  out 
each  of  these  items  In  the  day-book  unless  It  Is  de- 
sired to  have  an  absolute  record  of  what  each 
penny  was  spent  for;  a  simpler  way  is  to  have  a 
petty  cash  account  from  which  all  such  Items  are 
paid,  the  total  to  be  entered  In  the  day-book  at  the 
end  of  the  week  under  the  head  of  sundries.  The 
salary  of  the  operator  should,  of  course,  be 
charged  directly  to  the  expense  account  each  week, 
but  if  one  prefers,  the  amounts  withdrawn  may  be 
entered  in  the  personal  column  during  the  month 

70 


Journal  and  Ledger  Records. 

and  a  balance  struck,  and  the  amount  of  the  salary 
be  charged  to  expense  at  that  time. 

Entering  the  amounts  of  the  "  accounts  receiv- 
able "  and  the  "  accounts  payable  "  each  month, 
gives  a  still  further  insight  into  the  condition  of 
the  business.  In  the  business  world,  a  man  who 
does  not  know  exactly  "  where  he  is  at "  is  pretty 
apt  to  be  in  an  unsafe  position. 

By  using  a  card  system  for  keeping  the  accounts 
with  patients  and  making  the  day-book  entries  as 
suggested,  it  becomes  practically  unneccessary  to 
do  any  double-entry  bookkeeping  or  to  keep  a 
regular  ledger.  The  "  accounts  payable  "  will  be 
principally  for  dental  supplies,  stationery,  etc.,  and 
of  course  some  record  of  them  must  be  kept,  but 
there  are  several  simple  ways  of  doing  this.  If 
cash  is  paid  for  all  supplies  at  the  time  of  purchase 
the  regular  day-book  entry  will  be  all  that  is  neces- 
sary; if  a  monthly  account  is  run  with  the  supply 
houses  the  sales  slips  should  be  filed  and  checked 
off  with  the  regular  statement  received  each  month 
and  a  record  kept  of  the  total  amount.  If  these 
accounts  are  paid  in  full  at  the  end  of  the  month 
the  following  simple  plan  may  suffice;  if  not,  it 
would  be  better  to  keep  a  regular  ledger  record  of 
them. 


71 


The  Business  Problems  of  a  Profession, 


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73 


The  Business  Problems  of  a  Profession, 

These  suggestions  of  simple  bookkeeping  meth- 
ods are  intended  principally  for  the  average  one- 
man  practice,  and  with  the  idea  of  reducing  the 
amount  of  labor  required  to  the  minimum.  In  the 
case  of  a  large  practice,  where  assistant  operators 
and  a  regular  secretary  are  employed,  it  may  be 
better  to  use  the  regular  double-entry  system  of 
bookkeeping  throughout. 


in 


74 


CHAPTER  XVII. 

CREDITS    AND    COLLECTIONS. 

It  is  not  the  amount  of  business  or  the  number 
of  patients  that  determine  the  business  success  or 
failure  of  a  practice,  but  whether  the  cash  receipts 
will  equal  the  amount  of  the  expenses  and  will 
show  a  profit  at  the  end  of  the  year. 

Young  men  have  been  told,  all  too  frequently, 
that  they  should  not  think  of  money  in  connection 
with  their  work,  for  to  do  so  is  sordid  and  mer- 
cenary; but  they  should  think  only  of  the  beauty 
and  poetry  of  their  operations  and  the  good  they 
may  be  doing  their  fellow  man.  A  man  who  fol- 
lows these  precepts  literally  will  not  be  fulfilling 
his  whole  duty  to  society,  for  it  demands  that  a 
man  shall  care  for  his  own,  and  when  he  fails  to 
do  so  he  adds  a  burden  to  others  t^  is  morally 
unjust. 

No  man  is  called  upon  to  r<~  ir  services  that 
mean  an  actual  expense  to  him,  without  some  as- 
surance that  they  will  be  paid  for.  This,  of  course, 
does  not  refer  to  charity  work.  A  man  Is  justified 
in  giving  as  freely  to  charity  as  he  can  afford,  but 

75 


The  Business  Problems  of  a  Profession, 

charity  should  not  be  extended  to  "  dead  beats  "  or 
to  people  who  can  well  afford  to  pay  but  who 
will  not. 

There  are  many  men  who  have  sufficient  nerve 
to  undertake  any  kind  of  an  operation,  yet  lack  the 
moral  courage  to  Insist  on  being  paid  for  their 
services.  Such  a  course  Is  unwise  and  unjust  and 
leads  to  business  failure. 

The  best  time  to  discuss  with  a  patient  the  prob- 
able amount  of  the  fee  and  the  terms  of  payment 
Is  after  the  preliminary  examination  has  been  made 
and  the  appointments  are  to  be  arranged  for.  In 
large  cities  where  people  move  about  frequently 
and  little  Is  known  of  their  financial  standing,  It  Is 
perfectly  proper  and  good  business  policy  to  ask 
that  a  suitable  retainer  be  paid  In  advance.  This 
Is  the  usual  course  adopted  by  the  members  of  the 
legal  profession.  When  this  Is  not  feasible,  ar- 
rangements should  be  made  for  payments  at  the 
close  of  the  engagement,  or  at  a  definite  time  after 
the  work  Is  completed.  A  note  should  be  made 
upon  the  chart  of  the  arrangement  agreed  upon,  so 
that  no  question  will  be  raised  when  the  bill  Is  pre- 
sented. 

When  a  patient  is  known  to  be  financially  re- 
sponsible It  may  be  good  policy  not  to  ask  for  a 
retainer  but  to  send  a  bill  at  the  completion  of  the 
work.  It  Is  advisable,  however,  to  have  It  gener- 
ally understood  that  prompt  payment  is  expected 

76 


Credits  and  Collections, 

when  the  bill  is  presented  unless  some  special  ar- 
rangement has  been  made  to  the  contrary.  State- 
ments should  be  rendered  promptly  upon  the  com- 
pletion of  the  work.  If  a  considerable  amount  of 
time  is  allowed  to  elapse  before  the  statement  is  re- 
ceived the  patient  may  forget  what  was  done  and 
think  he  has  been  overcharged. 

A  good  form  for  a  professional  statement  or 
bill  will  be  about  as  follows: 


Mr - ^ 

to 
D.D.S. 

For  professional  services  rendered 

from 

to 

Received  payment 

An  itemized  statement  should  not  be  rendered. 
If  one  should  be  requested,  a  reply  can  be  made 
about  as  follows:  ''  The  bill  rendered  was  for  pro- 
fessional services  which  cannot  be  itemized,  like  so 
much  merchandise;  however,  by  referring  to  my 

records  I  find  that  there  were engagements, 

occupying    hours,   during  which  time  the 

following  operations  were  performed gold 

fillings,     amalgam    fillings,    the    surgical 

cleansing  of  the  teeth  and  roots   (or  whatever  it 

77 


The  Business  Problems  of  a  Profession. 

may  have  been),  my  customary  fee  for  the  service 
rendered  being  the  amount  stated  in  the  bill. 
Trusting  that  this  will  be  satisfactory,  Yours,  etc.'^ 
Such  a  reply  usually  ends  the  argument. 

All  bills  for  outstanding  accounts  should  be 
sent  out  promptly  at  the  end  of  each  month.  As 
many  people  pay  their  monthly  bills  in  the  order  in 
which  they  are  received,  it  is  a  good  plan  to  send 
out  the  bills  by  the  28th  of  the  month.  It  is  the 
early  bird  that  frequently  catches  the  worm.  In 
case  a  remittance  is  not  received,  it  will  be  well  in 
many  cases  to  send  another  bill  on  the  15th  of  the 
following  month.  If  an  account  is  still  outstand- 
ing at  the  end  of  the  second  month  a  bill  should 
be  sent  with  a  request  for  a  remittance  written 
upon  it.  Should  this  f  ailto  bring  a  response  within 
a  reasonable  length  of  time  a  letter  should  be  writ- 
ten stating  that  "  professional  fees  are  due  upon 
the  completion  of  the  work  and  that  credit  had 
been  given  only  as  a  matter  of  courtesy,  that  the 
account  is  overdue  and  a  remittance  is  expected." 
Accounts  that  remain  unpaid  for  three  months 
without  some  explanation  being  made  should  be 
followed  up  aggressively.  A  plan  that  sometimes 
works  effectively  is  to  have  the  office  attendant  call 
upon  the  debtor  and  present  the  bill  with  a  request 
for  an  answer.  If  this  is  not  expedient  or  should 
fail,  the  account  may  then  be  turned  over  to  a 
regular   collector.      A   professional   bill   collector 

78 


Credits  and  Collections. 

generally  produces  better  results  than  do  lawyers, 
who  usually  confine  their  efforts  to  writing  letters 
and  making  threats  that  are  seldom  anything  but 
a  bluff. 

In  places  where  there  are  several  dentists  who 
will  work  together,  it  would  be  a  good  plan  for 
them  to  agree  to  employ  the  same  collector.  In 
this  way  considerable  information  may  be  obtain- 
able regarding  the  people  that  are  slow  pay  or 
that  evade  payment  of  their  debts.  When  a  per- 
son is  known  to  be  poor  pay  or  a  dead  beat,  a  den- 
tist is  entirely  justified  in  declining  to  render  pro- 
fessional services  to  him  unless  payment  is  made  in 
advance. 

Lawyers  will  frequently  advise  bringing  suit  to 
collect  an  account,  but  it  is  seldom  advisable  to 
actually  take  a  case  into  court  unless  the  amount 
involved  is  sufficient  to  make  it  well  worth  while, 
for  the  legal  expenses  will  more  than  offset  any 
small  amount. 

Referring  again  to  the  rendering  of  bills,  we 
sometimes  hear  of  professional  men  who  only  send 
bills  to  their  patients  once  or  twice  a  year.  This 
may  be  all  right  in  a  few  exceptional  cases  where 
the  patients  are  more  than  well-to-do  or  the 
amounts  involved  are  small,  but  in  most  instances 
it  is  bad  business  policy  and  is  unfair  to  both  par- 
ties concerned.  In  the  first  place,  a  professional 
man  is  entitled  to  his  fee  when  the  service  is  ren- 

79 


The  Business  Problems  of  a  Profession, 

dered  or  as  soon  thereafter  as  is  practicable,  for  he 
has  expenses  which  should  be  met  promptly ;  again, 
when  a  bill  is  sent  to  a  patient  only  once  or  twice 
a  year,  they  have  no  means  of  checking  it  up  to 
determine  if  it  is  correct  and  must  depend  entirely 
on  the  honesty  of  the  doctor  and  the  assumption 
that  his  records  are  correct  beyond  question ;  then, 
too,  the  bill  may  be  for  a  large  amount  and  reach 
the  patient  at  such  a  time  as  will  make  it  a  hard- 
ship for  him  to  meet  it  within  a  reasonable  period. 
With  most  people  it  is  easier  and  more  convenient 
to  meet  small  bills  frequently  than  to  pay  large 
ones  at  an  unexpected  or  inconvenient  time.  When 
accounts  are  allowed  to  run  for  six  months  or  more, 
the  interest  on  the  amount  is  either  lost  or  must  be 
charged  in  the  bill ;  the  first  should  not  be  expected 
of  the  dentist  and  the  latter  is  seldom  expected  by 
the  patient. 

Dentists  have  been  frequently  heard  to  say  that 
they  have  been  too  busy  to  send  out  any  bills  for 
some  months ;  and  yet  upon  closer  questioning  they 
generally  admit  that  they  need  the  money  in  order 
to  meet  their  expenses;  and  it  quite  often  appears 
that  these  same  men  lose  from  ten  to  forty  per  cent 
of  the  amount  of  their  gross  business  through  ina- 
bility to  collect.  It  is  very  often  the  case  that 
these  same  men  will  continue  to  work  year  in  and 
year  out  for  people  who  seldom  or  never  pay  their 
bills  and  seem  satisfied  to  delude  themselves  with, 

80 


Credits  and  Collections, 

and  take  pride  In  talking  about,  the  size  of  their 
practice. 

Professional  men  are  proverbially  poor  business 
men,  and  in  no  way  do  they  show  it  more  than  in 
the  lax  way  in  which  they  handle  their  accounts. 


8i 


CHAPTER  XVIII. 

GENERAL    APPLICATION    OF    THE    HOUR    CHARGE. 

It  will  very  often  be  asked,  "  Do  you  charge  for 
examinations  or  treatments?"  The  answer  is  a 
decided,  yes.  Why  not  ?  A  dentist  certainly  does 
not  gape  into  a  person's  mouth  from  any  pleasure 
that  may  be  derived  from  so  doing,  but  because  it 
is  a  matter  of  business.  Patients  do  not  ask  a  den- 
tist to  examine  their  mouths  merely  to  satisfy  his 
supposed  curiosity  regarding  their  condition  but  to 
satisfy  their  own  and  to  get  some  advice.  In  order 
that  a  dentist  may  be  able  to  make  such  an  exami- 
nation and  give  competent  advice  about  the  condi- 
tion found,  it  is  necessary  that  he  should  have  a 
professional  education,  maintain  an  office  and  suit- 
able equipment,  and  consume  time  which  has  a 
definite  value  to  him.  This  being  the  case,  he 
should  ask  and  receive  a  fee  for  this  service  the 
same  as  for  any  other. 

As  a  general  rule,  an  examination  or  consulta- 
tion will  occupy  about  a  quarter  of  an  hour,  and  a 
regular  fee  for  this  service  should  be  established 
that  will  represent  a  fair  proportion  of  the  cus- 
tomary hour  charge.     If,  however,  the  service  re- 

82 


General  Application  of  the  Hour  Charge. 

quires  more  time  than  this,  the  fee  should  be  in- 
creased accordingly. 

For  all  general  operative  work  the  charge  is 
made  according  to  the  amount  of  time  involved. 

In  crown  work  the  regular  charge  is  made  for 
the  operative  time  (preparing  the  root,  fitting,  set- 
ting, etc.)  plus  a  laboratory  charge  which  should 
cover  the  cost  of  materials,  time,  and  a  fair  profit. 
Bridgework  is  estimated  in  the  same  way — that  is, 
a  definite  price  per  tooth  as  the  laboratory  charge 
plus  the  regular  fee  for  operative  time. 

In  case  of  dentures  it  may  seem  advisable  to 
have  a  definite  fee  for  each  of  the  various  kinds, 
but  the  rate  should  be  as  high  as  possible  and  be 
governed  largely  by  the  time  involved  and  the  ar- 
tistic ability  displayed. 

The  extraction  of  teeth  is  a  major  surgical  oper- 
ation that  may  involve  the  health  and  even  the  life 
of  the  patient,  and  it  should  always  be  considered 
as  such,  and  a  suitable  fee  asked  accordingly.  No 
self-respecting  professional  man  should  think  of 
performing  a  surgical  operation  for  what  is  con- 
sidered small  change  or  the  price  of  a  hair  cut;  nor 
should  a  surgical  operation  be  performed  without 
oharge  because  a  mechanical  one  is  to  follow  it,  as 
is  the  case  when  teeth  are  extracted  free  if  a  den- 
ture is  to  be  made.  If  the  services  of  a  dental  sur- 
geon are  not  worthy  of  a  higher  rating  than  this 
— why  be  one  ? 

83 


CHAPTER  XIX. 

INCREASING   THE    FEES. 

The  law  of  supply  and  demand,  which  has  to 
do  with  the  regulation  of  so  many  things  in  the 
business  world,  may  also  be  utilized  for  regulating 
professional  fees  as  well. 

In  a  previous  chapter  a  method  was  described 
whereby  a  dentist  could  determine  the  minimum 
fee  that  he  could  safely  afford  to  charge  if  some 
degree  of  financial  success  was  to  be  attained.  In 
the  chapter  on  appointments  it  was  suggested  that 
only  a  limited  number  of  engagements  be  planned 
for  each  day  and  the  days  filled  as  far  in  advance 
as  possible. 

In  applying  this  aforesaid  law,  the  limited  num- 
ber of  hours  and  a  reasonable  number  of  days  rep- 
resents the  supply,  and  the  number  of  appoint- 
ments that  can  be  made  represents  the  demand. 
When  the  number  of  patients  desiring  a  certain 
dentist's  services  becomes  so  great  that  his  appoint- 
ments are  made  weeks  in  advance  and  there  are 
still  requests  for  time,  then  he  is  justified  in  raising 
the  amount  of  his  fee  per  hour. 

84 


Increasing  the  Fees. 

This  will  tend  to  decrease  the  number  of  pa- 
tients, but  it  will  also  increase  the  income  of  the 
dentist  with  but  the  same  expenditure  of  energy 
on  his  part.  When  the  demand  for  his  services  at 
the  increased  rate  again  exceeds  a  reasonable  limit 
he  is  once  more  in  a  position  to  make  an  increase 
in  his  fees.  And  so  it  may  continue — the  limit  to 
which  fees  may  be  advanced  being  only  determined 
by  the  demand  for  services. 

In  the  meantime,  there  is  an  incentive  for  the 
dentist  to  render  the  very  best  services  in  his  power 
so  that  he  may  attract  an  increasing  number  of  bet- 
ter class  or  wealthier  patients.  Such  a  procedure 
means  an  everchanging  set  of  patients;  but  no  man 
need  feel  compelled  to  continue  to  render  his  serv- 
ices at  five  dollars  an  hour  if  he  is  able  to  obtain 
ten;  and  if  by  this  method  he  is  enabled  to  continu- 
ally improve  the  technique  and  value  of  his  serv- 
ices, thereby  increasing  his  income,  he  should  be 
satisfied  to  lose  patients  and  confine  his  attention  to 
those  who  can  appreciate  and  afford  them. 

Some  may  ask,  what  is  to  become  of  the  patients 
that  cannot  afford  to  pay  these  increased  fees? 
They  will  naturally  drift  to  the  younger  men 
whose  fees  may  still  be  low;  and  this  will  be  the 
means  of  giving  some  other  man  a  chance  to  get 
ahead.  It  will  then  work  out  the  same  as  it  does 
in  the  commercial  world — not  everyone  can  afford 
to  patronize  a  Tiffany,  but  there  are  always  shops 

85 


The  Business  Problems  of  a  Profession. 

of  all  degrees  to  meet  the  wants  of  all  purses;  nor 
are  these  shops  really  the  competitors  of  a  Tiffany, 
but  rather  they  serve  as  feeders,  for  it  is  but  human 
nature  to  desire  better  things  as  one's  income  in- 
creases ;  and  this  trait  shows  itself  in  all  things. 

The  only  competition  that  a  professional  man 
need  recognize  is  that  which  may  exist  between  his 
desires  and  his  ability. 

The  man  who  tries  to  work  for  all  the  people 
at  any  price  may  be  satisfied  with  his  success  up  to 
a  certain  point,  but  as  a  rule  he  is  one  that  is  doing 
but  very  little  to  advance  the  standards  of  his  pro- 
fession. 


86 


CHAPTER  XX. 

NOTES. 

A  SPECIFIC  treatise  on  any  method  or  its  appli- 
cation is  usually  limited  in  its  usefulness  to  the 
immediate  now  and  the  immediate  few,  while  the 
exposition  of  a  few  general  principles  may  be  of 
service  for  some  time  to  come.  Having  this  in 
mind  no  attempt  has  been  made  to  discuss  all  the 
phases  of  any  of  the  subjects  presented,  but  rather 
it  has  been  the  intention  to  suggest  an  idea  that 
might  establish  a  train  of  thought  in  the  mind  of 
the  reader  that  would  enable  him  to  adapt  the 
methods  to  his  own  practice,  and  with  the  hope  of 
arousing  a  wider  discussion  of  the  general  subject 
so  that  all  may  benefit  thereby. 

Very  little  has  been  said  about  the  technique  of 
operations,  for  it  is  taken  for  granted  that  every 
man  is  striving  to  attain  the  highest  standards  as 
an  operator  and  to  render  the  best  services  possible 
to  his  patients. 

It  would  be  possible  to  add  several  more  chap- 
ters to  this  book  on  such  subjects  as  general  de- 
portment, the  winning  of  patients,  etc.,  but  these 

87 


The  Business  Problems  of  a  Profession. 

subjects  have  been  handled  so  admirably  by  Dr. 
C.  N.  Johnson  in  his  treatise  "  Success  in  Dental 
Practice  "  that  the  writer  prefers  to  refer  his  read- 
ers to  that  book  for  the  information. 


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